Key result
Linear ablation from a cavotricuspid isthmus pouch to the inferior vena cava resulted in widely split double potentials without changing the atrial flutter cycle length, indicating parallel conduction.
Case Report (n=1)
No
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In patients with a deep pouch-like recess in the cavotricuspid isthmus, the flutter wavefront may split into parallel conduction paths, necessitating ablation on both sides of the pouch.
A 58-year-old man had typical cavotricuspid-isthmus-dependent atrial flutter (AFL). Right atrial angiography and multidetector computed tomography revealed a deep pouch-like recess in the mid-isthmus region. Linear ablation from the pouch to the edge of the inferior vena cava resulted in widely split double potentials without any change in the AFL cycle length. This observation suggested that the pouch played an electrophysiological role by dividing the flutter wavefront into 2 parallel conduction wave fronts through both sides of the pouch along the isthmus during typical AFL. When a widely split potential is created on 1 side of the pouch, the other side of the pouch should be targeted.
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Oginosawa et al. (2008) conducted a case report in Typical atrial flutter (n=1). Linear catheter ablation was evaluated on Electrophysiological response to ablation. Linear ablation from a cavotricuspid isthmus pouch to the inferior vena cava resulted in widely split double potentials without changing the atrial flutter cycle length, indicating parallel conduction.
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