Triple Loop Atrial Flutter Occurring After a Lung Transplant

Figures

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  FIGURE 1. Activation maps of the atrial flutters (AFLs) (left panels) and cardiac tracings recorded from the mapping catheters during the AFLs (right panels). Note that the multipolar mapping catheter was positioned within the left pulmonary vein (LPV) cuff (Panel‐A) and the left atrial appendage (LAA) (Panel B). CS, coronary sinus; CS 1 to 5, the first to fifth electrode pairs of the CS catheter; MA, mitral annulus; RPV, right pulmonary vein.

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  FIGURE 2. (A) Activation maps were recorded during the AFLs. The double lines indicate a line of conduction block between the LPV cuff and the left atrium. The red, yellow, and white circles indicate the reentrant loops of AFL‐1, AFL‐2, and AFL‐3, respectively. The orange and pink arrows indicate the activations around the mitral annulus, reflecting a “reverse‐C” pattern of the atrial activation sequence within the CS. The radiofrequency ablation was likely to have eliminated the 2 AFLs (red and yellow circles) first, resulting in the disappearance of the activations (orange arrows). Consequently, the remaining activation (pink arrow) was likely to have reflected the “distal to proximal” atrial activation sequence within the CS. The white arrowheads indicate electrical connections between the donor LPV cuff and recipient left atrium. (B) Activation maps exhibiting the catheter positions (left panels) and cardiac tracings exhibiting the changes during the successful ablation (right panels). The abbreviations are as in Figure 1.

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  FIGURE 3. Voltage maps recorded before and after the ablation (ABL). The green, light blue, and white tags indicate the ablation sites. The white arrowheads indicate electrical connections between the donor LPV cuff and the recipient left atrium. The abbreviations are as in Figure 1.