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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Heart Rhythm
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Integrated electroanatomic mapping with three-dimensional computed tomographic images for real-time guided ablations.Circulation. 2006; 113: 186-194
- A stochastic approach for automatic registration and fusion of left atrial electroanatomic maps with 3D CT anatomical images.Phys Med Biol. 2007; 52: 6323-6337
Published online: September 24, 2007
This work was supported by the Fondazione Cassa di Risparmio di Trento e Rovereto.
© 2008 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.