Image| Volume 5, ISSUE 1, P163-164, January 2008

Image fusion shows the role of incomplete ablation lines in creating a substrate for left atrial flutter occurring after atrial fibrillation ablation

Published:September 24, 2007DOI:
      A 56-year-old man with permanent atrial fibrillation (AF) underwent circumferential pulmonary vein (PV) ablation plus additional ablation of atrial areas having fractionated electrograms. An electroanatomic mapping system (CARTO, Biosense-Webster, Diamond Bar, CA, USA) was used during the procedure. Computed tomographic (CT) imaging of the left atrium (LA) performed 2 days before the ablation procedure showed a common trunk of the left PVs. Fractionated electrograms were concentrated mainly in the posterior portion of the left PV common trunk ostium. Three months later, the patient underwent a second electrophysiologic study for palpitation recurrence, with ECG demonstration of atypical atrial flutter. Biatrial electroanatomic mapping and entrainment pacing during the procedure showed the LA origin of the flutter, which was sustained by reentry involving the ridge between the left atrial appendage (LAA) and the left PV common trunk. Ablation of this region resulted in prompt termination of the arrhythmia. During 2-year follow-up, the patient experienced no recurrences of atrial tachyarrhythmias.


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