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Non-inducible Atrial Flutter in a Patient with Prior Surgery for Congenital Heart Disease (Example 1): Ablation Based on Substrate Mapping in Sinus Rhythm

Abstract

This is a 27-year-old male patient who at the age of 5 underwent surgical closure of an ostium secundum atrial septal defect using a Dacron patch. One year before the procedure described here, he began complaining of palpitations, with the ECG equivalent of atrial flutter (Fig. 1) of 240 ms cycle length. The P wave morphology was very similar to that of typical atrial flutter, although symmetric negative P waves were present in the inferior leads, instead of the classic “saw-tooth” morphology. Moreover, unlike typical atrial flutter, the P wave morphology in V1 was biphasic, with a predominant negative late component. Initially, the patient refused the procedure and was cardioverted, but the arrhythmia recurred with the same morphology in the following months. Consequently, the patient accepted the procedure and was referred for ablation while on a persistent episode of atrial flutter. The day before the procedure, probably as a result of its prolonged duration, the arrhythmia degenerated into atrial fibrillation. A previous transthoracic echocardiography in sinus rhythm showed no marked dilation of the heart chambers and normal ventricular function. Preprocedure transoesophageal echo cardiogram excluded intracavitary thrombi.

Keywords

Sinus Rhythm Coronary Sinus Atrial Flutter Conduction Block Atrial Septum 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    De Ponti R, Ho SY, Salerno-Uriarte JA et al. Electroanatomic analysis of sinus impulse propagation in the normal human atria. J Cardiovasc Electrophysiol 2002; 13:1–10.CrossRefGoogle Scholar
  2. 2.
    Lemery R, Soucie L, Martin B et al. Human study of biatrial electrical coupling: determinants of endocardial septal activation and conduction over interatrial connections. Circulation 2004; 110: 2083–2089.PubMedCrossRefGoogle Scholar
  3. 3.
    Love BA, Collins KK, Walsh EP, Triedman JK. Electroanatomic characterization of conduction barriers in sinus/atrially paced rhythm and association with intra-atrial reentrant tachycardia circuits following congenital heart disease surgery. J Cardiovasc Electrophysiol 2001; 12: 17–25.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

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