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Electroanatomical mapping and ablation of upper loop reentry atrial flutter
Apostolos Katsivas1, Panagiotis Ioannidis, Charalambos Vassilopoulos
1Electrophysiology Laboratory, Hellenic Red Cross Hospital, Athens, Greece. AKatsivas@mail.gr
Summary
This study details a rare atrial flutter case in a 75-year-old man. Three-dimensional mapping precisely located the circuit around the superior vena cava, enabling successful radiofrequency ablation.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Upper loop reentry is a rare, non-isthmus-dependent atrial flutter.
- This specific circuit involves reentry around the superior vena cava.
- Concomitant sick sinus syndrome can complicate diagnosis and management.
Observation:
- A 75-year-old male patient presented with symptoms suggestive of atrial flutter.
- Diagnostic evaluation utilized advanced three-dimensional electroanatomical mapping (ENSITE 3000 system).
- Both non-contact and detailed three-dimensional contact mapping were employed to delineate the reentry circuit.
Findings:
- The reentry circuit followed a clockwise path around the superior vena cava.
- A critical conduction gap within the crista terminalis was identified as the circuit's critical isthmus.
- Radiofrequency ablation targeting this conduction gap effectively terminated the atrial flutter.
Implications:
- This case highlights the utility of integrated non-contact and contact 3D mapping for complex atrial flutter.
- Successful ablation of superior vena cava-dependent atrial flutter provides a potential therapeutic strategy.
- Understanding such reentry circuits improves diagnostic accuracy and treatment outcomes for rare arrhythmias.