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Case Reports
. 2017 May 23;5(7):1103-1106.
doi: 10.1002/ccr3.998. eCollection 2017 Jul.

Atrial flutter in a patient with atrial septal defect and anomalous venous drainage: unusual approach for ablation

Ivo Roca-Luque  1 , Nuria Rivas  1 , Laura Dos  2 , Jaume Francisco  1 , Jordi Pérez-Rodon  1 , Antònia Pijuan  2 , David Garcia-Dorado  3 , Àngel Moya  1
Affiliations
Case Reports

Atrial flutter in a patient with atrial septal defect and anomalous venous drainage: unusual approach for ablation

Ivo Roca-Luque et al. Clin Case Rep. .

Abstract

Atrial flutter ablation in CHD (Congenital Heart Disease) patients is a challenging procedure because of the possibility of multiple circuits. Electroanatomical mapping and pacing maneuvers are crucial to determine critical isthmus. Moreover, vascular abnormalities and residual cardiac defects need to be known before the ablation to decide the better strategy for ablation.

Keywords: Ablation; atrial flutter; congenital heart disease; vascular abnormalities.

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Figures

Figure 1
Figure 1
Upper panel shows surface ECG with atrial flutter, positive F waves in inferior leads. Bottom left panel: CT scan with residual ASD (upper arrow) and with anomalous drainage of inferior vena cava (bottom arrow). Bottom right panel: LAO view of electroanatomical reconstruction of both atria, confirming drainage of IVC into left atria.
Figure 2
Figure 2
Upper panel shows activation map of both right and left atria. Activation of left atrium is passive and two different circuits are suggested: one counterclockwise circuit around lateral scar (left) and a clockwise circuit around tricuspid annulus (right). Left bottom panel shows entrainment from border zone of lateral scar with PPI‐TCL >30 msec (91 msec) excluding this area as a critical isthmus of clinical flutter. Right bottom panel shows entrainment from cavotricuspid isthmus with PPI‐TCL < 30 msec (3 msec) and concealed fusion, confirming that cavotricuspid isthmus is the protected isthmus of the circuit.
Figure 3
Figure 3
Upper left panel shows slowing of TCL from 331 to 358 msec during ablation in posterior part of cavotricuspid isthmus through. Bottom left panel shows slowing TCL from 358 to 409 msec and stop of flutter during ablation of a gap area of anterior isthmus, through IVC and residual ASD (catheter positioned as showed in fluoroscopy image).
See this image and copyright information in PMC

References

    1. Triedman, J. K. 2002. Arrhythmias in adult patients with congenital heart disease. Heart 87:383–389. - PMC - PubMed
    1. Chan, D. , Van Hare G., Mackall J., Carlson M., and Waldo A.. 2000. Importance of atrial flutter ishtmus in postoperative intra‐atrial reentrant tachycardia. Circulation 102:1283–1289. - PubMed
    1. Triedman, J. K. , Alexander M., Berul C., Bevilacqua L., and Walsh E.. 2001. Electroanatomical mapping of entrained and exit zones in patients with repaired congenital heart disease and intra‐atrial reentrant tachycardia. Circulation 103:2060–2065. - PubMed
    1. El Yamman, M. , Asirvatham S., Kapa S., Barrett R., Packer D., and Porter C. B.. 2009. Methods to access the surgically excluded cavotricuspid isthmus for complete ablation of typical atrial flutter in patients with congenital heart defects. Heart Rhythm 6:949–956. - PubMed
    1. Guenther, K. , Marrouche M., and Ruef J.. 2007. Ablation of atrial flutter by the femoral approach in the absence of inferior vena cava. Europace 2007; 9: 1073–1074. - PubMed

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