This case demonstrates that irregular atrial flutter following pulmonary vein isolation can be CTI-dependent and successfully treated with linear ablation of the CTI.
May support CTI ablation for irregular post-PVI flutter; hypothesis-generating and requires prospective confirmation.
A 65‐year‐old man with a history of refractory paroxysmal atrial fibrillation (AF) underwent catheter ablation for persistent AF lasting 2 months. AF was not terminated after complete isolation of the 4 pulmonary veins (PV). Instead, it was transformed to a sustained atrial tachyarrhythmia with beat‐to‐beat variability in the atrial cycle length. A 12‐lead electrocardiogram during tachycardia showed negative flutter‐like waves in the inferior leads. Entrainment pacing along the tricuspid annulus confirmed the diagnosis of irregular cavotricuspid isthmus (CTI)‐dependent typical atrial flutter (AFL). Linear ablation of the CTI terminated AFL and restored sinus rhythm.
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Irie et al. (2012) studied this question.
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