5. Atrial Tachycardia, Atrial Flutter & WPW Syndrome: 5.1 Ablation of Incisional Reentrant Tachycardia Caused by Lung Transplantation

A 58 year old female underwent orthotopic left lung transplantation for emphysema. She enjoyed rapid recovery from her surgical procedure but developed almost daily episodes of symptomatic palpitations, persisting 32 months following transplant.

Electrocardiogram demonstrated atypical atrial flutter, and she reported to the electrophysiology (EP) laboratory for mapping and catheter ablation.

At EP study, she was found to have left atrial flutter, cycle length 230 ms, with variable atrioventricular conduction. Entrainment and activation mapping were both consistent with left atrial origin. Transseptal mapping demonstrated high frequency fractionated diastolic atrial electrograms recorded from the site of posterior anastamosis between the grafted pulmonary vein and the left atrium. Post pacing intervals recorded from this site were identical to the tachycardia cycle length. A single radiofrequency lesion terminated the tachycardia, rendering the patient noninducible. She has remained free of symptoms for over six months post ablation.

This is the first published report of incisional reentrant atrial tachycardia involving a lung transplant. Standard entrainment mapping and radiofrequency ablation techniques proved satisfactory in curing the arrhythmia.