Key result
Linear ablation of the cavotricuspid isthmus successfully eliminated a typical atrial flutter that mimicked a pacemaker-mediated tachycardia due to severe conduction delay.
Case Report (n=1)
Typical atrial flutter can mimic a pacemaker-mediated tachycardia in patients with severe conduction delay through the cavotricuspid isthmus.
Consider cavotricuspid isthmus flutter in suspected pacemaker-mediated tachycardia; case report leaves open broader applicability.
A 64-year-old man with a history of congestive heart failure secondary to nonischemic cardiomyopathy, mitral and aortic valve replacements, and biventricular cardioverter-defibrillator placement, developed a tachycardia. The tachycardia exhibited a biventricular paced rhythm with a short R-P interval and concentric atrial activation sequence within the coronary sinus, suggesting that the tachycardia might be a pacemaker-mediated tachycardia (PMT). However, the tachycardia was diagnosed as counterclockwise cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL), and linear ablation of the CTI eliminated the tachycardia. This case illustrated that typical AFL can mimic a PMT when there is a severe conduction delay through the CTI.
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Yamada et al. (2018) conducted a case report in Atrial flutter mimicking pacemaker-mediated tachycardia (n=1). Linear ablation of the cavotricuspid isthmus (CTI) was evaluated on Elimination of tachycardia. Linear ablation of the cavotricuspid isthmus successfully eliminated a typical atrial flutter that mimicked a pacemaker-mediated tachycardia due to severe conduction delay.
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