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AVRT Case with Coronary CTO Explained

This case report describes a 56-year-old man with atrioventricular reentrant tachycardia (AVRT) and a history of coronary artery disease affecting two vessels. The man presented with a one day history of palpitations. Electrocardiography showed narrow complex tachycardia. Echocardiography revealed decreased left ventricular function and mild left ventricular diastolic dysfunction. Coronary angiography demonstrated chronic total occlusion of the left circumflex artery and right coronary artery. The patient underwent an electrophysiological study and radiofrequency ablation. Ablation of a posteroseptal accessory pathway terminated the tachycardia. This case demonstrates AVRT can occur in a patient with significant coronary artery disease

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Nanank Akhiruddin Syamsa
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97 views2 pages

AVRT Case with Coronary CTO Explained

This case report describes a 56-year-old man with atrioventricular reentrant tachycardia (AVRT) and a history of coronary artery disease affecting two vessels. The man presented with a one day history of palpitations. Electrocardiography showed narrow complex tachycardia. Echocardiography revealed decreased left ventricular function and mild left ventricular diastolic dysfunction. Coronary angiography demonstrated chronic total occlusion of the left circumflex artery and right coronary artery. The patient underwent an electrophysiological study and radiofrequency ablation. Ablation of a posteroseptal accessory pathway terminated the tachycardia. This case demonstrates AVRT can occur in a patient with significant coronary artery disease

Uploaded by

Nanank Akhiruddin Syamsa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Atrioventricular reentrant tachycardia (AVRT) with chronic total occlusion (CTO) in Left

Circumflex and Right Coronary Artery: What is Reentry Mechanism ? : A Case Report

M. Akhiruddin, Department of Cardiology and Vascular Medicine, Faculty of Medicine, University


of Hasanuddin, Makassar, Indonesia
Muzakkir Amir, Electrophysiologist, Department of Cardiology and Vascular Medicine, Faculty of
Medicine, University of Hasanuddin, Makassar, Indonesia

Background: Supraventricular Tachycardia (SVT) are triggered by a reentry mechanism.


Atrioventricular reentrant tachycardia (AVRT) is another common form of paroxysmal SVT.
Paroxysmal SVT is observed not only in healthy individuals; it is also common in patients with
previous myocardial infarction, mitral valve prolapse, chronic lung disease. AVRT results from the
presence of 2 or more conducting pathways. The accessory pathways may conduct impulses in an
anterograde conduction, a retrograde conduction, or both. Most of these accessory pathways are
located between the left ventricle and left atrium or in the posteroseptal area, less often between the
right ventricle and right atrium. Management of patients with concealed accessory pathways
divided into acute treatment and ongoing management of orthodromic AVRT. In this report, we
describe a case of Atrioventricular reentrant tachycardia (AVRT) with history of Coronary Artery
Disease two Vessels Disease (CAD 2VD).
Case report: A 56-year-old man admitted to the hospital with major complaints of palpitation since
1 day and no chest pain. History of recurrent palpitation since 3 months ago. He has history of
smoking and coronary angiography was CAD 2VD. On admission, ECG in ER showed Narrow
QRS complex tachycardia with heart rate 180 bpm, regular, ST depression at lead V2-V6,
q patologis di lead III,aVF. The laboratory result within normal limit. From echocardiography we
found decreased LV systolic function and mild LV diastolic dysfunction. Result of Coronary
Angiography showing chronic total occlusion (CTO) in Left Circumflex and Right Coronary
Artery. The patient has performed procedure electrophysiological (EP) Study and radiofrequency
ablation (RFA). Three quadripolar catheter was inserted and placed in RV apex, His bundle, HRA
via femoral vein . One decapolar catheter placed in CS via internal jugular vein. Pacing from RVA
showed retrograd conduction and programmed atrial stimulation induced SVT. The SVT have
morphology AVRT posteroseptal accesories pathway. Ablation cathether was placed at the
posteroseptal accessory pathway and multiple radiofrequency ablation (RFA) were done. After RFA
at the accessory pathway and then pacing could not reinduced SVT. The procedure of
electrophysiolgy study and ablation is complete without complication.
Conclusion:
AVRT with CTO in LCX and RCA is a rare case with recurrent palpitation presentation. As
physicians, we need to be highly vigilant in clinical evaluation. This Case report a 56 year old
Male with atrioventricular reentrant tachycardia (AVRT) and coronary artery disease two
vessels disease has performed procedure of electrophysiological (EP) Study and
radiofrequency ablation (RFA) by electrophysiologist.
Biography

M. Akhiruddin has completed general doctor from Faculty of Medicine, University of Hasanuddin,
Makassar, Indonesia. Currently, he is completing specialist education programe in Department of
Cardiology and Vascular Medicine, University of Hasanuddin, Makassar, Indonesia.

Presenting author details


Full name: dr Muhammad Akhiruddin Wanreng
Age : 34 years old
E-mail ID: [email protected]
Contact number:+6282377769923 (WA)
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Category: Poster presentation

Note: Mention all the abbreviation in the abstract.

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