Radiofrequency ablation of the cavotricuspid isthmus is the first-line treatment for typical atrial flutter. Despite the close proximity of the right coronary artery (RCA) to the cavotricuspid isthmus, only four cases of arterial injury have been reported during radiofrequency ablation, all detected postablation by inferior ST elevation. Here, we report atrioventricular (AV) conduction delay during coronary sinus pacing as a possible early sign of RCA involvement and review the previous literature on RCA damage and variations of AV nodal circulation.
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Atypical Atrial Flutter: Electrophysiological Characterization and Effective Catheter Ablation.
J Cardiovasc Electrophysiol
January 2025
Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland.
Atrial flutter (AFL), defined as macro-re-entrant atrial tachycardia, is associated with debilitating symptoms, stroke, heart failure, and increased mortality. AFL is classified into typical, or cavotricuspid isthmus (CTI)-dependent, and atypical, or non-CTI-dependent. Atypical AFL is a heterogenous group of re-entrant atrial tachycardias that most commonly occur in patients with prior heart surgery or catheter ablation.
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Department of Cardiology, CHU HELORA Jolimont Hospital, La Louvière, Belgium.
This case report discusses the management of a 75-year-old man who developed an unusual type of atypical atrial flutter following a previous pulmonary vein isolation for paroxysmal atrial fibrillation. Despite a second attempt to re-isolate the pulmonary veins and performing cavotricuspid isthmus ablation (which was suspected to be part of the arrythmia circuit), the flutter continued and was converted to sinus rhythm through electrical cardioversion. A few weeks later, the patient's atrial tachycardia relapsed.
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Cardiovascular Centre, Fukuoka City Hospital, 13-1 Yoshizukahon-machi, Hakata-ku, Fukuoka 812-0046, Japan.
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J Cardiovasc Electrophysiol
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Cardiology Division, Geneva University Hospitals, Geneva, Switzerland.
Typical atrial flutter (AFL), defined as cavotricuspid isthmus (CTI)-dependent macro-re-entrant atrial tachycardia, often causes debilitating symptoms, and is associated with increased incidence of atrial fibrillation, stroke, heart failure, and death. Typical AFL occurs in patients with atrial remodeling and shares risk factors with atrial fibrillation. It is also common in patients with a history of prior heart surgery or catheter ablation.
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