Video 1 : Atypical flutter with atrial ILAM correlating with the critical isthmus. This case supports the validity of atrial ILAM as a strategy for the empiric ablation of atypical atrial flutter.įigure 1: A: Atrial ILAM with right atrial pacing. This review aims at highlighting mechanism, diagnosis and treatment of atypical AFL and the recent developments in electroanatomic mapping. Ablation in this region terminated the tachycardia. We previously demonstrated a catheter ablation approach employing rapid multielectrode activation mapping with targeted entrainment manoeuvrs. Subsequent induction of the arrhythmia was possible and activation mapping suggested the previously identified region was the critical isthmus. Atrial tachycardias are clinically challenging arrhythmias that can occur in the presence of atrial scaroften due to either cardiac surgery or prior ablation for atrial fibrillation. The arrhythmia could not be induced at the start of the case subsequently, a left atrial map with high right atrial pacing was created and we identified a deceleration zone on the anterior left atrium ( Figure 1 and Video 1 ). We report a case of left atrial mapping performed using the Advisor™ HD Grid Mapping Catheter, Sensor Enabled™ in a patient referred for atypical atrial flutter ablation after prior pulmonary vein isolation. Creating an ILAM of the left atrium has not been systematically evaluated and it is not known whether additional ablation in these areas improves freedom from all atrial arrhythmias. As an alternative, ultra–high-density mapping during sinus rhythm allows for the creation of isochronal late-activation maps (ILAMs) in patients with ventricular tachycardia and facilitates the identification of a critical isthmus even without induction of the ventricular arrhythmia. However, while induction of the arrhythmia is fundamental to the ablation strategy, this may not be universally possible. 1 Catheter ablation for the management of CTI-dependent AFL is consi. Email: of atypical atrial flutter is an increasingly challenging and prevalent problem. Atypical AFL is not dependent on the CTI and may be either macro re-entrant as in peri-mitral, left atrial roof dependent or scar related (from prior ablation or surgery) atypical AFL or micro re-entrant (2 cm in diameter) AFL, which often resemble a focal atrial tachycardias. Atrial flutter ablation is a procedure to destroy cells in your heart that are causing atrial flutter, an abnormal rhythm of the heart. Kapur receives consulting fees/honoraria from Abbott, Medtronic, and Novartis.Īddress correspondence to: Sunil Kapur, MD. Atrial isochronal late-activation mapping, atypical atrial flutter, critical isthmus.ĭr. Atypical Flutter with Atrial Isochronal Late-activation Map Correlating with the Critical Isthmusġ Brigham and Women’s Hospital, Boston, MA, USA
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