Double-loop Reentry in the Right Atrium with a Shared Mid-Diastolic Isthmus in a Postsurgical Patient: Identifying and Targeting the Shared Isthmus


This is a 49-year-old male patient who five years earlier was operated on for mitral and aorticvalve replacement. The subsequent follow-up was uneventful until 1 month before the procedure described here, when the patient began complaining of dyspnea, which worsened in the following weeks. At his first examination, initial-stage congestive heart failure with regular 2:1 atrial flutter and a ventricular rate of 125 beats/min was diagnosed. The atrial flutter morphology (Fig. 1) resembled that of a typical reverse form (positive P waves in leads I, II, III, aVF, V3-V6, negative in aVR, V1-V2 and flat in aVL), although an isoelectric line was present between P waves. After appropriate therapy for congestive heart failure, the patient underwent an electrophysiologic procedure while in arrhythmia.


Ablation Catheter Atrial Flutter Tricuspid Annulus Left Anterior Oblique Reentrant Circuit 
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© Springer-Verlag Italia 2008

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