Key result
Radiofrequency catheter ablation successfully terminated both a typical isthmus-dependent flutter and an atypical scar-related flutter in a single patient, with no recurrence at one year.
Why the study?
Predicting the prognosis and managing the diagnosis and treatment of complex cases with coexisting multiple mechanisms of atrial flutter continues to pose challenges.
Case Report (n=1)
No
Simultaneous typical and atypical scar-related atrial flutter can be successfully managed with 3D mapping and targeted radiofrequency catheter ablation of both circuits.
Suggests possible ankylosing spondylitis–atrial flutter link; leaves open confirmation in larger studies before clinical implications.
Atrial flutter, a common cardiac arrhythmia, is characterized by rapid and regular atrial contractions that result in a characteristic sawtooth pattern on the electrocardiogram. It emerges due to the formation of reentrant electrical circuits within the atria, giving rise to structured, sawtooth-patterned atrial waves as observed on electrocardiography. We present the case of a 52-year-old female with a medical history of ankylosing spondylitis, dyslipidemia, and a previous surgical closure of an atrial septal defect. The patient developed a rare form of atrial flutter, characterized by two distinct mechanisms: a clockwise isthmus-dependent flutter and an atypical scar-related flutter around the atriotomy scar. In order to effectively address this complex condition, a successful ablation procedure was performed to target both mechanisms. This case report offers valuable insights into the complexities surrounding the diagnosis and treatment of a complex case characterized by the coexistence of multiple mechanisms of atrial flutter within a single patient. While catheter ablation has demonstrated improved success rates for typical and atypical atrial flutters when occurring in isolation, predicting the prognosis of complex cases continues to pose challenges.
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Ouartassi et al. (2023) conducted a case report in Simultaneous reverse typical and atypical atrial flutter (n=1). 3D mapping and radiofrequency catheter ablation was evaluated on Termination of flutter and restoration of sinus rhythm. Radiofrequency catheter ablation successfully terminated both a typical isthmus-dependent flutter and an atypical scar-related flutter in a single patient, with no recurrence at one year.
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