A case of frequent premature atrial complexes secondary to aortic compression of the right atrium

doi:10.11958/20251486

Abstract

Abstract:

A 78-year-old male patient presented with significant dilation of the non-coronary sinus of the aorta, which compressed the right atrium and formed a local low-voltage area, resulting in frequent polymorphic atrial premature beats (24-hour load 40.9%). Through dual-chamber combined activation mapping, the target point (right atrial appendage - tricuspid valve annulus junction) was locked. After radiofrequency ablation, atrial premature beats disappeared, and there was no recurrence during the follow-up period of six months. Currently, there are many causes of atrial arrhythmias related to atrial compression, but it is extremely rare for the right atrium to be involved and cause isolated frequent atrial premature beats. Treatment should be individualized, choosing either interventional or surgical methods, and emphasizing the interpretation of anatomical-electrical correlations using multimodal imaging (ultrasound, CT angiography, three-dimensional electroanatomical system).

Key words: atrial premature complexes, radiographic image interpretation, computer-assisted, aortic valve stenosis

CLC Number:

R541.7

Figures/Tables 4

References 21

[1]	PAGE R L, JOGLAR J A, CALDWELL M A, et al. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia:a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society[J]. J Am Coll Cardiol, 2016, 67(13):e27-e115. doi:10.1016/j.jacc.2015.08.856.
[2]	DEWLAND T A, VITTINGHOFF E, MANDYAM M C, et al. Atrial ectopy as a predictor of incident atrial fibrillation:a cohort study[J]. Ann Intern Med, 2013, 159(11):721-728. doi:10.7326/0003-4819-159-11-201312030-00004.
[3]	CHATTERJEE N A, SHAH R V, MURTHY V L, et al. Right ventricular structure and function are associated with incident atrial fibrillation: mesa-rv study(multi-ethnic study of atherosclerosis-right ventricle)[J]. Circ Arrhythm Electrophysiol, 2017, 10(1):e004738. doi:10.1161/CIRCEP.116.004738.
[4]	LUI J K, MCINTOSH L J, ESCOBAR VALLE J, et al. Facial drooping,aphasia, and an incidental lung mass in a nonsmoker[J]. J Intensive Care Med, 2017, 32(3):228-230. doi:10.1177/0885066616676044.
[5]	BAYRAKTAR U D, DUFRESNE A, BAYRAKTAR S, et al. Esophageal cancer presenting with atrial fibrillation:a case report[J]. J Med Case Rep, 2008, 2:292. doi:10.1186/1752-1947-2-292.
[6]	KUWABARA H, TSUJI H, INADA Y, et al. Malignant pleural mesothelioma forming a huge mediastinal mass and causing atrial fibrillation[J]. Indian J Pathol Microbiol, 2012, 55(4):513-515. doi:10.4103/0377-4929.107794.
[7]	RAWLS W B, ANCONA V C. An unusual case of paroxysmal auricular fibrillation due to mediastinal malignant lymphoma[J]. Am Heart J, 1951, 41(2):311-315. doi:10.1016/0002-8703(51)90109-3.
[8]	MAZZELLA A J, FRIED A J, HICKS C. Atrial dysrhythmias due to extrinsic left atrial compression by an esophageal stent[J]. HeartRhythm Case Rep, 2021, 7(4):216-219. doi:10.1016/j.hrcr.2021.01.006.
[9]	KHAN Z, BATCHELOR T, REES P. Bronchogenic cyst:a rare cause of palpitations and atrial fibrillation[J]. BMJ Case Rep, 2024, 17(3):e259480. doi:10.1136/bcr-2023-259480.
[10]	MIZOBUCHI M, TACHI T, YAMASHITA T. Atrial tachycardia in a patient with severe pectus excavatum[J]. Heart Rhythm, 2023, 20(4):631-632. doi:10.1016/j.hrthm.2023.01.016.
[11]	ELFIKY A, EL IMAD C T, KARAM B, et al. Polycystic liver with cardiac compression leading to atrial fibrillation:case report and review of the literature[J]. Cureus, 2020, 12(5):e7976. doi:10.7759/cureus.7976.
[12]	NAKATANI Y, SUDO T, SUZUKI J, et al. Cryoballoon ablation for atrial fibrillation in a patient with esophageal dilatation due to achalasia[J]. HeartRhythm Case Rep, 2023, 9(7):461-464. doi:10.1016/j.hrcr.2023.04.010.
[13]	UNDAVIA M, SINHA S, MEHTA D. Radiofrequency ablation of swallowing-induced atrial tachycardia: case report and review of literature[J]. Heart Rhythm, 2006, 3(8):971-974. doi:10.1016/j.hrthm.2006.04.010.
[14]	COOPER M J, DELORIMIER A A, HIGGINS C B, et al. Atrial flutter-fibrillation resulting from left atrial compression by an intrapericardial lipoma[J]. Am Heart J, 1994, 127(4 Pt 1):950-951. doi:10.1016/0002-8703(94)90573-8.
[15]	MAYOSI B M. Pericarditis-associated atrial fibrillation[J]. Heart, 2015, 101(18):1439-1440. doi:10.1136/heartjnl-2015-307917.
[16]	EJIMA K, SHODA M, MIYAZAKI S, et al. Localized reentrant tachycardia in the aorta contiguity region mimicking perimitral atrial flutter in the context of atrial fibrillation ablation[J]. Heart Vessels, 2013, 28(4):546-549. doi:10.1007/s00380-012-0294-x.
[17]	FRANCO E, RODRÍGUEZ MUÑOZ D, MATÍA FRANCÉS R, et al. Catheter ablation of peri-hisian atrial tachycardia from the noncoronary sinus of valsalva after aortic valve replacement[J]. Rev Esp Cardiol (Engl Ed), 2019, 72(4):355-357. doi:10.1016/j.rec.2018.06.001.
[18]	TSUTSUI K, KONDO A, OHTA T, et al. Peri-mitral atrial tachycardia following transcatheter aortic valve replacement[J]. JACC Case Rep, 2025, 30(6 Pt 1):102967. doi:10.1016/j.jaccas.2024.102967.
[19]	YAZAKI K, AJIRO Y, MORI F, et al. Multiple focal and macroreentrant left atrial tachycardias originating from a spontaneous scar at the contiguous aorta-left atrium area in a patient with hypertrophic cardiomyopathy: a case report[J]. BMC Cardiovasc Disord, 2017, 17(1):29. doi:10.1186/s12872-016-0448-3.
[20]	YAN W, XIE Y, CAI P, et al. A giant left atrial appendage aneurysm with recurrent chest tightness and atrial tachycardia:Multimodal imaging findings[J]. Radiol Case Rep, 2023, 18(3):805-808. doi:10.1016/j.radcr.2022.11.062.
[21]	HO I, HEIST E K, ARYANA A, et al. Compression of the left atrium by the thoracic aorta in patients undergoing pulmonary vein isolation procedure for atrial fibrillation[J]. J Interv Card Electrophysiol, 2007, 19(1):29-36. doi:10.1007/s10840-007-9134-9.