Radiofrequency catheter ablation for drug-refractory atrial tachyarrhythmias in a patient with catecholaminergic polymorphic ventricular tachycardia: A case report

Patients with catecholaminergic polymorphic ventricular tachycardia (CPVT) frequently have atrial arrhythmias, such as atrial tachycardia (AT) and fibrillation (AF), in addition to the ventricular tachyarrhythmias. The development of AT/AF in patients with CPVT is associated with adverse outcomes, and its management is still challenging. A 43-year-old woman with CPVT underwent radiofrequency catheter ablation (RFCA) for drug-refractory AT/AF. Pulmonary vein isolation (PVI) was carried out prior to AT ablation. Repetitive rapid firing from the left superior PV occurred frequently during PVI. After completion of PVI, the firing disappeared, but both polymorphic VT and multifocal ATs were induced by infusion of isoproterenol (ISP) (0.5 mcg/min). The origins of the two ATs were in the right atrium (RA) posterior septum [cycle length (CL), 285 ms] and ostium of the coronary sinus (CS) (CL, 235 ms). Electrophysiologic evaluation revealed that the earliest activation occurred at the RA posterior septum and CS ostium, preceding the onset of P waves by 52 ms and 84 ms, respectively. Application of radiofrequency energy at the site terminated ATs. After RFCA of the two ATs and PVI, no atrial tachyarrhythmias were induced by continuous ISP administration (0.5 mcg/min). <Learning objective: A 43-year-old woman with catecholaminergic polymorphic ventricular tachycardia (CPVT) underwent radiofrequency catheter ablation (RFCA) for drug-refractory atrial tachyarrhythmias (AT/AF). Catecholamine hypersensitivities were observed in the right atrium and pulmonary veins (PVs) as well as the ventricle. Multiple ATs originating from not only a PV but also non-PVs should be considered for elimination of AT/AF in CPVT patients.>