Persistent Atrial Flutter Treated by Coronary Sinus Ablation in Persistent Left Superior Vena Cava

Area of Science:

• Cardiology
• Electrophysiology
• Cardiac Imaging

Background:

• Atypical atrial flutter ablation can be challenging, especially with complex cardiac substrates.
• Persistent left superior vena cava and coronary sinus dilatation are associated with arrhythmogenic potential.

Purpose of the Study:

• To investigate the arrhythmogenic substrate in a challenging case of atypical atrial flutter.
• To identify the critical area for ablation in a patient with complex atrial flutter.

Main Methods:

• Utilized extensive substrate and activation mapping techniques.
• Performed detailed electrophysiological mapping to identify critical areas.

Main Results:

• The critical arrhythmogenic substrate was localized within the coronary sinus.
• Mapping revealed complex activation patterns contributing to the flutter.

Conclusions:

• The coronary sinus can harbor critical substrates for atypical atrial flutter, particularly in the presence of anatomical variations.
• Targeting the coronary sinus is crucial for successful ablation in such complex cases.