Patient D., 34 years old admitted to the tachyarrhythmia surgical treatment unit at the Medical Center with the diagnosis "Postmyocardium cardiosclerosis. Frequent atrial ectopic premature heartbeats".
Monitored around the clock with a Holter ECG in the preoperative period there was registered frequent atrial premature heartbeats up to 2 thousand beats per 24 hours.
The patient underwent Non-invasive EPI using the "AMYCARD 01 C" system.
The analysis was based on ECG fragment that included atrial premature heartbeats complex of a typical morphology (Fig. 1).

Fig. 1.  Patient D. Atrial ectopic premature heartbeats. Selection of atrial premature heartbeats complex.

Isopotential map revealed concentrically spreading area of negative potential in the right atrium in the region of coronary sinus, testifying the location of ectopic focus in this part of the atriums (Fig.  2).

Fig. 2.  Patient D. Atrial ectopic premature heartbeats. Ectopic focus in the area of coronary sinus.  Isopotential map of the atriums.

To determine the sequence of the atrium activation dichromatic maps in the FND mode were built (Fig.  3), maps of myocardium activation direction (Fig. 4), isochronous maps and maps of activation spread in the ADM mode (Fig. 5).

   
   

Fig. 3.  Patient D. Atrial ectopic premature heartbeats. Ectopic focus in the area of coronary sinus.  Dichromatic map of atrium activation spread.

Fig. 4.  Patient D. Atrial ectopic premature heartbeats. Ectopic focus in the area of coronary sinus.  Vector field of atrium activation directions.

Fig. 5.  Patient D. Atrial ectopic premature heartbeats. Ectopic focus in the area of coronary sinus.  Isochronous map of the atriums, based on vector field of atrium activation.

 
   
   
   

Fig. 6.  Patient D. Atrial ectopic premature heartbeats. Ectopic focus in the area of coronary sinus.  Maps of atrium activation spread based on vector field of myocardium activation directions.

Various methods of activation mapping allowed determining the location of ectopic focus in the right atrium in the region of coronary sinus. 

An invasive EPI confirmed the location of ectopic focus.  The patient underwent a successful radiofrequency ablation.  Monitored around the clock with a Holter ECG in the postoperative period there was revealed consistent sinus rhythm.

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