Key result
Anterior LA wall RF ablation can cause interatrial dissociation and complete sinus-to-AV node block.
Case Report (n=1)
Extensive ablation procedures, especially in cases with prior cardiac surgeries, must account for the anatomical location of intra- and inter-atrial connections to avoid complete block to the AV node.
Warrants caution with anterior LA ablation to preserve AV conduction; case leaves open optimal mapping strategies in re-do flutter procedures.
INTRODUCTION: A middle-age woman underwent an electrophysiologic study due to recurrent atypical atrial flutter. METHODS AND RESULT: Radiofrequency ablation of cavotricuspid isthmus and anterior mitral line was performed. During energy delivery on the anterior left atrial wall, interatrial dissociation and complete block of the sinus impulse to the atrioventricular (AV) node was observed. AV node activation became dependent on a subsidiary left atrial rhythm. CONCLUSION: Anatomical location of intra and inter-atrial connections must be taken into account when performing extensive ablation procedures, specially in cases with prior cardiac surgeries.
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Jiménez et al. (2021) conducted a case report in Recurrent atypical atrial flutter (n=1). Radiofrequency ablation of cavotricuspid isthmus and anterior mitral line was evaluated on Interatrial dissociation and complete block of the sinus impulse to the atrioventricular node. Radiofrequency ablation of the anterior left atrial wall in a patient with atypical atrial flutter resulted in interatrial dissociation and complete block of the sinus impulse to the AV node.
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