A Case of LA-RA Dissociation with Atrial Tachycardia after Surgical Extirpation of Myxoma

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The patient was sixty-one year old male admitted to our cardiovascular center for treatment of atrial tachycardia after extirpation of myxoma 5 years ago. Baseline ECG at electro-physiological study showed sinus rhythm with complete AV block. Intracardiac electrocardiogram revealed that RA was excited by sinus rhythm, and LA and lower RA near the AV node were excited by V-A conduction of junctional rhythm. Several atrial tachycardias were induced by pacing from CS. RA was excited by sinus rhythm during atrial tachycardias. After PV isolation and linear ablation between right PV and left PV were performed, mitral isthmus dependent atrial tachycardia was remained. Atrial tachycardia was terminated by linear ablation between RIPV and mitral annulus. Sinus rhythm was recovered in all chambers by DDAT mode pacing at RA, CS branch and RV. We reported a rare case of LA-RA dissociation with atrial tachycardia.