Related Experiment Video
Updated: Jan 17, 2026

Donor Posterior Atrial Flap Rotation for Left Atrial Cuff Reconstruction in Lung Transplantation
Published on: October 11, 2024
Mechanism of Typical Atrial Flutter in a Patient After Cardiac Transplant: Functional Slowing From Geometric
Alejandro Plana1, Jeremy S Treger1, Jonathan Grinstein2
1The University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, Chicago, Illinois, USA.
Background:
Atrial flutter and atrial fibrillation occur after orthotopic heart transplant (OHT) in 25% of patients. Hemodynamic and medication restrictions in this unique population limit treatment.
Case Summary:
A patient experienced prolonged episodes of paroxysmal atrial flutter and hypotension 8 days after OHT. Electrophysiology study demonstrated typical cavotricuspid isthmus (CTI)-dependent flutter, with slowing at the CTI midportion. Intracardiac echocardiography revealed that this site was distant from any suture lines or anastomoses. The slowing appeared to be secondary to geometric distortion (ie, "buckling" of the atrial wall) of the CTI.
Discussion:
Typical atrial flutter caused by functional slowing from structural distortion is distinct from prior reports of atrial flutter attributed to conduction block from suture lines. Computational models support the hypothesis that tissue curvature changes can lead to altered atrial conduction properties.
Take-Home Message:
Functional slowing from geometric distortion should be considered as a cause of atrial flutter in the post-OHT setting.
Related Concept Videos
Dysrhythmias IV: Characteristics of Bradyarrhythmias
Mechanism of Cardiac Arrhythmias
Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias

