JACC. Case reports · 2026
Multifocal Atrial Tachycardia and Genetic Background-Guided Ablation Strategy for Atrial Fibrillation in a Young Woman.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Kong Ling-Cong, Shuang Tian, Xu Bi-He, Wang Xin-Hua
Аннотация
BACKGROUND: Atrial fibrillation (AF) typically affects the elderly persons. Personalized therapy for young patients needs to be considered.
CASE SUMMARY: A 28-year-old young woman presented with recurrent palpitations for over 10 years and had previously received a diagnosis of "paroxysmal AF" elsewhere. She experienced recurrence postablation and poor drug response. A repeated electrophysiological study indicated multifocal atrial tachycardia, primarily 2 types originating from the sinus venosus, and successful ablation was performed. No atrial arrhythmias were observed during 6-month postoperative follow-up. The familial predisposition was genetically confirmed, with the patient carrying a pathogenic TNNI3K gene variant.
DISCUSSION: This case was challenging because of unstable activation sequences. A sequential ablation strategy targeting individual morphologies was crucial. The strong family history underscored the role of genetic testing.
TAKE-HOME MESSAGES: Cautious, nonempirical management is vital for young patients with "AF". Non-pulmonary vein, embryologically categorized AF triggers should be considered. Genetics can elucidate the underlying substrate.
CASE SUMMARY: A 28-year-old young woman presented with recurrent palpitations for over 10 years and had previously received a diagnosis of "paroxysmal AF" elsewhere. She experienced recurrence postablation and poor drug response. A repeated electrophysiological study indicated multifocal atrial tachycardia, primarily 2 types originating from the sinus venosus, and successful ablation was performed. No atrial arrhythmias were observed during 6-month postoperative follow-up. The familial predisposition was genetically confirmed, with the patient carrying a pathogenic TNNI3K gene variant.
DISCUSSION: This case was challenging because of unstable activation sequences. A sequential ablation strategy targeting individual morphologies was crucial. The strong family history underscored the role of genetic testing.
TAKE-HOME MESSAGES: Cautious, nonempirical management is vital for young patients with "AF". Non-pulmonary vein, embryologically categorized AF triggers should be considered. Genetics can elucidate the underlying substrate.