Catheter Ablation of Atrial Tachycardia/Flutter in a Patient with Giant Right Atrium after Tricuspid Valve Replacement for Traumatic Tricuspid Valve Regurgitation

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A 44-year-old female was referred to our hospital for catheter ablation (CA) for symptomatic paroxysmal atrial tachycardia/flutter (AT/AFL) resistant to anti-arrhythmic drugs (AADs). At 15 years of age, she suffered blunt thoracic trauma due to traffic accident. Tricuspid valve regurgitation had noticed later, then she underwent tricuspid valve replacement (TVR) three times at 18, 20, 27 years of age. After surgery, she complained of repeated palpitation due to AT/AFL. Giant right atrium (RA) was observed on echocardiography and right atriogram. Programmed stimulation easily induced multiple AT/AFL, at least 5 types. We could make mapping of three of them. One of them consisted of macro-reentrant pattern like figure-8, and two of them consisted of focal pattern. We performed CA for those AT/AFL without complications. Eventually, the inducibility and durability of those AT/AFL decreased. Some literature reports the TVR after blunt thoracic trauma; however, to our knowledge, this is the first case of CA for such patient. We think severity of damage of right atrium increases susceptibility to develop of AT/AFL. CA is feasible, safe, and effective in those patients.