Non-inducible Atrial Flutter in a Patient with Prior Surgery for Congenital Heart Disease (Example 2): Substrate Mapping in Sinus Rhythm with the Help of Imaging Integration


This a 49-year-old male patient who at the age of 24 underwent surgical closure of an ostium secundum atrial septal defect with a prosthetic patch. One year before the procedure, he began complaining of recurrent palpitations, documented at 12-lead ECG as atrial flutter with 240 ms cycle length. The morphology was consistent with a typical reverse form with negative P waves in V1-V2 and positive P waves in the inferior and lateral leads (Fig. 1). Most of the time, the arrhythmia was very symptomatic and required the patient’s hospitalisation and treatment by DC-cardioversion. For this reason, he was referred for an electrophysiologic procedure while on sinus rhythm.


Sinus Rhythm Atrial Septal Defect Atrial Flutter Tricuspid Annulus Electroanatomic Mapping 
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© Springer-Verlag Italia 2008

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