Organised Atrial Arrhythmias after Atrial Fibrillation Ablation in the Left Atrium (Example 1): an Arrhythmogenic Incomplete Linear Lesion with Modified Left-to-right Atrial Propagation
This is a 61-year-old male patient with hypertension and only mild dilatation of the left atrium. At the age of 54, he underwent ablation for typical atrial flutter with complete bidirectional block of cavotricuspid isthmus conduction. Three years later, in another hospital, he underwent electrophysiologically guided pulmonary-vein isolation for recurrent atrial fibrillation refractory to multiple antiarrhythmic drugs and, during the same hospital stay, three ablation procedures were performed. The ablation strategy included a linear lesion between the mitral annulus and the right superior pulmonary vein os. In the months following ablation, atrial fibrillation did not recur, but the patient did experience episodes of palpitation. ECG documented atrial tachycardia with a stable cycle length of 280 ms and flat P wave morphology in all leads, except V1, which showed a distinct positive P wave (Fig. 1). In the month before undergoing the procedure described below, the arrhythmia became persistent, was poorly tolerated and required electrical cardioversion. Upon arrhythmia recurrence, the patient was hospitalised to undergo an electrophysiologic procedure.
KeywordsAtrial Fibrillation Pulmonary Vein Left Atrium Atrial Tachycardia Atrial Activation
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