A Peculiar Clockwise Peritricuspid Atrial Flutter: the Exception to the Rule of Aiming at the Mid-diastolic Isthmus

Abstract

This is a 51-year-old male patient with a history of idiopathic paroxysmal atrial fibrillation. Five years prior to the procedure described here, he underwent catheter ablation of atrial fibrillation in our centre, with electrical disconnection of the pulmonary veins. Subsequently, he was arrhythmia-free, until six months before the second procedure, when he began complaining of palpitation recurrence. This was documented on electrocardiogram as typical reverse atrial flutter (Fig. 1), with a cycle length of 250 ms, a prolonged surface P wave (160 ms) and predominantly 2:1 atrioventricular conduction. During a persistent episode, the patient was again referred to our institution for the second electrophysiology procedure.