Front. Cardiovasc. Med.

Sec. Cardiac Rhythmology

Volume 11 - 2024 | doi: 10.3389/fcvm.2024.1424187

Provisionally accepted

The final, formatted version of the article will be published soon.

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Introduction Focal atrial tachycardia (FAT) is predominant in the pediatric population. Recent research has identified cases of sustained FAT originating from the interatrial septum (IAS); a subset of cases presents a unique challenge, with foci originating from the peri-patent foramen ovale (peri-PFO), requiring specialized management during catheter ablation. Here, we present a rare case of peri-PFO-associated FAT that resulted in tachycardia-related cardiomyopathy and propose a comprehensive multipath joint strategy for the successful treatment of PFOassociated FAT.Case presentation A 10-year-old boy presented with refractory cardiomyopathy associated with incessant atrial tachycardia, unresponsive to metoprolol. A 12-lead electrocardiogram revealed a narrow QRS complex tachycardia with a rate of 157 beats per minute and a prolonged RP relationship. Echocardiography indicated a severely reduced ejection fraction of 22%. Subsequent electrophysiological study findings identified the tachycardia as originating from the anterior limbus of the PFO. Radiofrequency ablation was performed at the earliest activation site and surrounding structures, encompassing the right atrial septum, non-coronary sinus of Valsalva, and the left atrium peri-PFO. Post-procedure, the patient remained free from arrhythmia and showed restored normal cardiac function and was prescribed a low-dose βblocker for 1 month. Remarkably, the patient continued to be well without the need for any medications for the subsequent 3 months.The structure of the PFO brought significant challenges in performing successful ablation. The multipath strategy was beneficial in managing peri-PFO-associated FAT based on its anatomical vicinity of the target.

Keywords: atrial tachycardia, Catheter Ablation, Tachycardia associated cardiomyopathy, patent foramen ovale, Managing strategy, case report

Received: 27 Apr 2024; Accepted: 17 Dec 2024.

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