Three-dimensional nonfluoroscopic electroanatomic mapping successfully identified and guided the ablation of a gap in the linear lesion line causing atypical left atrial flutter post-AF ablation.
Case Report (n=1)
Atypical left atrial flutter following intraoperative AF ablation can be successfully mapped and ablated percutaneously using 3D electroanatomic mapping to target gaps in linear lesions.
Curative treatment of chronic atrial fibrillation (AF) remains a challenging task for electrophysiologists. Eliminating the initiating triggers by focal radiofrequency ablation in a subset of patients with paroxysmal AF and modifying the maintaining substrate by performing linear lesions within the left atrium in patients with prolonged episodes of AF are among the alternative approaches for management of these patients. Recently, a new intraoperative treatment procedure aimed at eliminating left atrial anatomic "anchor" reentrant circuits by induction of contiguous lesions using radiofrequency energy under direct vision was introduced. However, atypical left atrial flutter may occur during follow-up after intraoperative ablation of AF. These arrhythmias most likely are due to discontinuities in linear lesions; therefore, they can be successfully mapped and ablated in a subsequent percutaneous catheter ablation procedure. We report and discuss the case of a patient who underwent successful intraoperative ablation of chronic AF, but who developed atypical left atrial flutter postoperatively. Three-dimensional nonfluoroscopic electroanatomic mapping revealed a gap in the linear lesion line connecting the left upper and right upper pulmonary vein orifices. Ablation at the exit site of the breakthrough was successful.
Duru et al. (2001) conducted a case report in Atypical left atrial flutter after intraoperative radiofrequency ablation of chronic atrial fibrillation (n=1). Three-dimensional nonfluoroscopic electroanatomic mapping and percutaneous catheter ablation was evaluated on Successful ablation of atypical left atrial flutter. Three-dimensional nonfluoroscopic electroanatomic mapping successfully identified and guided the ablation of a gap in the linear lesion line causing atypical left atrial flutter post-AF ablation.