What question did this study set out to answer?

To describe the utility of ultra-high-definition mapping in identifying complex biatrial macro-reentry circuits and guiding targeted catheter ablation in recurrent atypical atrial flutter.

April 24, 2019EP Europace

Ultra-high-definition mapping in biatrial macro-reentrant tachycardia: a case study

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Population

A 68-year-old man with recurrent atypical AFL after two previous RF ablations

Design

Case study

Authors

FTFabrizio TundoCentro Cardiologico Monzino ARAntonio Dello RussoElectrophysiology MCMichela CasellaElectrophysiology

Discussion

Member takes

Implication

Recurrent AFL after multiple prior lines warrants cautious mapping; leaves open optimal ablation strategies in post-ablation patients.

Key Points

To describe the utility of ultra-high-definition mapping in identifying complex biatrial macro-reentry circuits and guiding targeted catheter ablation in recurrent atypical atrial flutter.
Evaluated a 68-year-old male presenting with recurrent atypical atrial flutter following two previous left and right atrial radiofrequency ablation procedures.
Performed electroanatomic activation mapping of both atria using an ultra-high-definition mapping catheter (Intellamap Orion) during induced atrial tachycardias.
Validated re-entrant circuits with entrainment pacing maneuvers and delivered radiofrequency energy at identified critical conduction sites.
Activation mapping identified a biatrial macro-reentrant tachycardia (cycle length 300 ms) propagating via an epicardial interatrial connection that bypassed an anterior conduction block.
Ablation at the earliest right atrial insertion site terminated the macro-reentrant arrhythmia and revealed a localized micro-re-entry tachycardia (cycle length 320 ms) at the left ridge.
A single focused radiofrequency delivery at the micro-re-entrant site restored and maintained sinus rhythm without procedural complications.

Structured PICO

Population

68-year-old man without history of structural heart disease, with recurrent atypical atrial flutter after two previous radiofrequency ablations (n=1)

Intervention

Ultra-high-definition mapping (Intellamap Orion) and radiofrequency ablation

Outcome

Restoration of sinus rhythm and termination of arrhythmia

Ultra-high-definition mapping is effective for identifying and treating complex biatrial macro-reentrant tachycardias in patients with prior extensive ablations.

Cite This Study

Tundo et al. (2019) studied this question.

synapsesocial.com/papers/6a6f9686660549caf2c41fe8 https://doi.org/10.1093/europace/euz146

Topics

AF ablation outcomes

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Ultra-high-definition mapping in biatrial macro-reentrant tachycardia: a case study

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Ultra-high-definition mapping in biatrial macro-reentrant tachycardia: a case study

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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