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Introduction: In patients with prior atrial septal defect (ASD) closure and atrial tachyarrhythmias, transseptal puncture can be challenging. Methods and Results: This case report discusses a 65‐year‐old man who had previously undergone pulmonary vein isolation (PVI) and cavo‐tricuspid isthmus ablation for atrial fibrillation before ASD closure, respectively. He developed atrial tachycardia (AT) and underwent catheter ablation. AT was diagnosed as peri‐mitral flutter and the mitral isthmus (MI) linear ablation via a trans‐aortic approach successfully terminated it. Conclusion: This case demonstrates the feasibility and safety of transaortic MI linear ablation in patients with ASD closure devices or anatomical challenges when transseptal puncture is difficult. [ABSTRACT FROM AUTHOR]

Although it is common for bi‐atrial tachycardia (AT) circuits to include the Bachmann bundle, there are few reports of its role in left AT circuits. A 77‐year‐old man was admitted for recurrent AT with a cycle length of 425 ms. The endocardial and epicardial activation map revealed an AT circuit located in the left atrial anterior wall and transverse pericardial sinus, showing a centrifugal pattern stemming from the left atrial appendage. After radiofrequency ablation, AT was no longer induced. This case suggests that the Bachmann bundle may be part of the left AT circuit. [ABSTRACT FROM AUTHOR]

Introduction: In patients with coronary artery disease, a high coronary artery calcium score (CACS) correlates with atrial fibrillation (AF); however, the association between left atrial (LA) remodeling progression and coronary arteriosclerosis is unclear. This study aimed to evaluate the relationship between LA remodeling progression and the CACS. Methods: This retrospective study enrolled 148 patients with AF (paroxysmal AF, n = 94) who underwent catheter ablation. Voltage mapping for the left atrium and coronary computed tomography for CACS calculations were performed. The ratio of the LA low‐voltage area (LA‐LVA), defined by values less than 0.5 mV divided by the total LA surface without pulmonary veins, was calculated. Patients with LA‐LVA (<0.5 mV) >5% and ≤5% were classified as the LVA (n = 30) and non‐LVA (n = 118) groups, respectively. Patient characteristics and CACS values were compared between the two groups. Results: LA volume, age, CHA2DS2VASc score, and percentage of female patients were significantly higher, and the estimated glomerular filtration rate was lower in the LVA group than in the non‐LVA group. The CACS was significantly higher in the LVA group (248.4 vs. 13.2; p =.001). Multivariate analysis identified the LA volume index and CACS as independent predictors of LA‐LVA (<0.5 mV) greater than 5%. The areas under the receiver operating characteristic curves for predicting LA‐LVA (<0.5 mV) greater than 5% with CACS were 0.695 in the entire population, 0.782 in men, and 0.587 in women. Conclusion: Progression of LA remodeling and coronary artery calcification may occur in parallel. A high CACS may indicate advanced LA remodeling, especially in men. [ABSTRACT FROM AUTHOR]

Scar-Related Left Atrial Anterior Wall Reentry. Introduction: Macroreentrant atrial tachycardia (MRAT) has been described most frequently in patients with prior cardiac surgery. Left atrial tachycardia and flutter are common in patients who undergo atrial fibrillation ablation; however, few reports describe left atrial MRAT involving the regions of spontaneous scarring. Here, we describe left atrial MRAT in patients without prior cardiac surgery or catheter ablation (CA) and discuss the clinical and electrophysiological characteristics of tachycardia and outcome of CA. Methods and Results: An electrophysiological study and CA were performed in 6 patients (3 men; age 76 ± 6 years) with MRAT originating from the left atrial anterior wall (LAAW). No patient had a history of cardiac surgery or CA in the left atrium. Spontaneous scars (areas with bipolar voltage ≤ 0.05 mV) were observed in all patients. The activation map showed a figure-eight circuit with loops around the mitral annulus (4 counterclockwise and 2 clockwise) and a low-voltage area with LAAW scarring. The mean tachycardia cycle length was 303 ± 49 milliseconds. The conduction velocity was significantly slower in the isthmus between the scar in the LAAW and the mitral annulus than in the lateral mitral annulus (0.17 ± 0.05 m/s vs 0.94 ± 0.35 m/s; P = 0.003). Successful ablation of the isthmus caused interruption of the tachycardia and rendered it noninducible in all patients. Conclusion: Spontaneous LAAW scarring is an unusual cause of MRAT, showing activation patterns with a figure-eight configuration. Radiofrequency CA is a feasible and effective treatment in such cases. (J Cardiovasc Electrophysiol, Vol. 24, pp. 404-412, April 2013) [ABSTRACT FROM AUTHOR]

A 79‐year‐old woman with a history of pulmonary vein isolation for persistent atrial fibrillation was admitted for recurrence of atrial tachycardia, with a tachycardia cycle length of 236 milliseconds. The ultra–high‐resolution mapping system revealed that tachycardia circuit detouring the epicardium at the anterior wall scar and breaking through to the endocardium below the left atrial appendage. Radiofrequency energy was applied to this site, which successfully terminated the tachycardia. This case suggests that epicardial conduction could occur even at the left atrial anterior wall and identifies a variation in epicardial conduction around the left atrium, which could be a tachycardia circuit. [ABSTRACT FROM AUTHOR]