Successful Zero-Fluoroscopy Ablation of an Atypical Clockwise Simple-Loop Biatrial Flutter Involving the Bachmann...

Area of Science:

• Electrophysiology
• Cardiac Anatomy

Background:

• Atrial flutter can occur after atrial fibrillation ablation procedures.
• Perimitral atrial flutter is a common target for ablation, but complications can arise.

Observation:

• A 69-year-old woman presented with atypical clockwise biatrial flutter post-anterior mitral line ablation.
• Local activation mapping and entrainment maneuvers were used to delineate the flutter circuit.

Findings:

• The flutter circuit involved an epicardial connection through the Bachmann bundle region.
• Successful radiofrequency ablation was achieved at the left lateral atrial insertion of the Bachmann bundle.

Implications:

• This case highlights the importance of understanding atrial anatomy, including epicardial bridging.
• Accurate mapping and entrainment analysis are crucial for successful ablation of complex atrial arrhythmias.
• This strategy may improve outcomes for patients with post-ablation atrial flutter.