Management of macro-reentrant right atrial tachycardia around multiple leads aided by high-density mapping

Background: A 61-year-old male with Steinert Dystrophy and prior history of cardiac implantable device complained of highly symptomatic right atrial tachycardia. Unresponsive to pharmacological therapy. Methods: The patient underwent catheter ablation procedure aided by high-density mapping. Results: Ablation procedure was succesful. Conclusions: This unique case report highlights the role of high-density mapping in the identification of critical isthmus and management of macro-reentrant tachycardia in complex situations such as the presence of multiple leads in the chamber.