Pulsed Field Ablation of Atypical Atrial Flutter in a Patient After Hybrid Ablation of Atrial Fibrillation

Figures

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  FIGURE 1. Voltage and activation maps from the first and second endocardial ablations. (A) This map of the left atrium from the first endocardial ablation shows the initial PFA anterior mitral line was delivered to the right and left superior PVs and the RF anterior mitral line ablation was delivered to the left superior PV. (B) The activation map from the second endocardial ablation shows recurrence of counterclockwise atypical atrial flutter encircling the initial PFA anterior mitral line to the right and left superior PVs. (C) The voltage map from the second endocardial ablation shows reconnection of the PFA anterior mitral line to the right and left superior PVs. (D) During the second endocardial ablation, repeat PFA anterior mitral lines were delivered using four PFA “stamp” applications. The first PFA application (white arrow) resulted in atypical flutter termination.

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  FIGURE 2. Intracardiac electrograms during stage 2 of hybrid atrial fibrillation ablation. (A) Occurrence of atypical atrial flutter. (B) Termination of atypical atrial flutter upon RFA of the anterior mitral line to the left superior PV.

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  FIGURE 3. Intracardiac electrogram of atypical atrial flutter termination with ablation. During the repeat endocardial ablation, the atypical flutter terminated upon the first PFA application along the anterior mitral line.