Successful ablation of cavotricuspid isthmus–dependent flutter through a mechanical tricuspid valve

Figure 1. 12-lead electrocardiogram demonstrating typical atrial flutter with 2:1 atrioventricular conduction.

Figure 2. Computed tomography chest demonstrating the attitude of the tricuspid prosthesis relative to the valvular plane and coronary sinus (CS) ostium. Proximal CS annotated with asterisk (∗).

Figure 3. Activation map during tachycardia demonstrating clockwise flutter. A small portion of the tachycardia cycle length has not been accounted for in association with the heavily scarred cavotricuspid isthmus.

Figure 4. A fluoroscopic right anterior oblique view of the ablation catheter guided across the mechanical prosthesis with an Agilis sheath (Abbott), and retroflexed to the cavotricuspid isthmus.

Figure 5. Termination of atrial flutter during ablation of the cavotricuspid isthmus.