Atypical Cases of Typical Atrial Flutter? A Case Study

Roberto De Ponti; Jacopo Marazzato; Fabio Angeli; Manola Vilotta; Federico Blasi; Giuseppe Bagliani; Fabio M Leonelli; Raffaella Marazzi

doi:10.1016/j.ccep.2022.03.004

Atypical Cases of Typical Atrial Flutter? A Case Study

Card Electrophysiol Clin. 2022 Sep;14(3):483-494. doi: 10.1016/j.ccep.2022.03.004. Epub 2022 Aug 25.

Authors

Roberto De Ponti¹, Jacopo Marazzato², Fabio Angeli³, Manola Vilotta⁴, Federico Blasi², Giuseppe Bagliani⁵, Fabio M Leonelli⁶, Raffaella Marazzi⁴

Affiliations

¹ Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy. Electronic address: roberto.deponti@uninsubria.it.
² Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy.
³ Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS, Via Crotto Roncaccio, 16, Tradate, Varese 21049, Italy.
⁴ Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy.
⁵ Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti Umberto I-Lancisi-Salesi", Via Conca 71, Ancona 60126, Italy.
⁶ Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA.

PMID: 36153128
DOI: 10.1016/j.ccep.2022.03.004

Abstract

Ablation of typical atrial flutter has a high safety and efficacy profile, but hidden pitfalls may be encountered. In some cases, a longer cycle length with isoelectric lines is associated with a different or more complex arrhythmogenic substrate, which may be missed if conduction block of the cavotricuspid isthmus is performed in the absence of the clinical arrhythmia. Prior surgery may have consistently modified the atrial substrate and complex or multiple arrhythmias associated with an isthmus-dependent circuit can be encountered. In these cases, electroanatomic mapping is useful to guide the procedure and plan an appropriate ablation strategy.

Keywords: Atypical atrial flutter; Catheter ablation; Electroanatomic mapping; Electrophysiologic study; Typical atrial flutter.

Publication types

Case Reports
Review

MeSH terms

Atrial Flutter* / surgery
Catheter Ablation* / methods
Heart Atria
Heart Block
Humans
Treatment Outcome