Key result
SVC isolation eliminates biatrial flutter with anomalous Bachmann bundle insertion, maintaining sinus rhythm at 6 months.
Case Report (n=1)
This case report highlights a unique biatrial flutter circuit involving an anomalous connection between the superior vena cava and Bachmann bundle, successfully treated with superior vena cava isolation.
SVC isolation may resolve rare biatrial flutter from anomalous Bachmann insertion; hypothesis-generating and should not yet change practice.
Key Teaching Points•Prior cardiac surgery or atrial fibrillation ablation can predispose patients to the development of atypical atrial flutter.•Although an eccentric coronary sinus activation pattern during atrial flutter suggests a left atrial circuit, entrainment from the right atrium should still be performed to exclude a biatrial flutter circuit.•Suspicion for biatrial flutter should be heightened in the setting of prior cardiac surgery or extensive ablation in the anteroseptal left atrium, as it can promote reentry over Bachmann bundle superiorly and the interatrial septum inferiorly.•We report a unique biatrial flutter that involves an anomalous insertion of Bachmann bundle into the superior vena cava, which was successfully ablated with superior vena cava isolation. •Prior cardiac surgery or atrial fibrillation ablation can predispose patients to the development of atypical atrial flutter.•Although an eccentric coronary sinus activation pattern during atrial flutter suggests a left atrial circuit, entrainment from the right atrium should still be performed to exclude a biatrial flutter circuit.•Suspicion for biatrial flutter should be heightened in the setting of prior cardiac surgery or extensive ablation in the anteroseptal left atrium, as it can promote reentry over Bachmann bundle superiorly and the interatrial septum inferiorly.•We report a unique biatrial flutter that involves an anomalous insertion of Bachmann bundle into the superior vena cava, which was successfully ablated with superior vena cava isolation.
No takes yet. Share an insight, caveat, or question.
Gracia et al. (2018) conducted a case report in Biatrial flutter (n=1). Superior vena cava isolation was evaluated on Maintenance of normal sinus rhythm. Superior vena cava isolation successfully treated a unique biatrial flutter involving an anomalous insertion of the Bachmann bundle into the superior vena cava, maintaining sinus rhythm at 6 months.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: