Key result
High-density mapping confirms true CTI block despite IVC pseudo-conduction, yielding 0% recurrence at 9 months.
Why the study?
Bidirectional cavotricuspid isthmus (CTI) block is the procedural endpoint of typical atrial flutter ablation, but pseudo-conduction may mimic residual isthmus conduction.
Case Report (n=1)
High-density mapping can differentiate true residual conduction from pseudo-conduction caused by rapid activation around the inferior vena cava during cavotricuspid isthmus ablation, preventing unnecessary ablation.
Answers are grounded in this paper and cite their sources.
Differential pacing may falsely suggest residual CTI conduction post-ablation; leaves open need for validated endpoints in larger studies.
BACKGROUND: Bidirectional cavotricuspid isthmus (CTI) block is the procedural endpoint of typical atrial flutter ablation, but pseudo-conduction may mimic residual isthmus conduction. CASE SUMMARY: A 45-year-old man underwent CTI ablation for typical atrial flutter. After linear ablation, a short double-potential interval and simplified differential pacing suggested residual conduction near the inferior vena cava (IVC). Additional ablation at this region failed to change the activation pattern. High-density mapping ultimately confirmed complete CTI block, whereas rapid activation around the IVC reached the lateral right atrium early, creating a pseudo-residual conduction pattern. The patient had no complications and remained free from recurrence during 9-month follow-up. DISCUSSION: Rapid conduction around the IVC may confound conventional criteria for CTI block. TAKE-HOME MESSAGE: High-density mapping may help differentiate true residual conduction from pseudo-conduction and prevent unnecessary ablation.
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Shen et al. (2026) conducted a case report in Typical atrial flutter (n=1). Cavotricuspid isthmus ablation with high-density mapping was evaluated on Bidirectional cavotricuspid isthmus block and freedom from recurrence. High-density mapping confirmed complete CTI block despite pseudo-conduction around the IVC, with 0% recurrence during 9-month follow-up.
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