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.
KeywordsAblation Catheter Atrial Flutter Tricuspid Annulus Left Anterior Oblique Reentrant Circuit
Unable to display preview. Download preview PDF.
- 1.El Sherif N, Mehra R, Gough WB, Zeiler RH. Reentrant ventricular arrhythmias in the late myocardial infarction period: interruption of reentrant circuits by cryothermal techniques. Circulation 1983; 8: 644–656.Google Scholar
- 2.El Sherif N, Restivo M, Gough WB. The figure of eight model of reentrant ventricular rhythms in the subacute phase of myocardial infarction. In: Shenasa M, Borggrefe M, Breithardt G, eds. Cardiac Mapping. Mount Kisco, NY, Futura Publishing Co; 1993: 159–182.Google Scholar