Mapping multiple atrial flutter re-entry circles after previous cryoballoon pulmonary vein isolations and multiple radiofrequency ablations can be challenging even for experienced specialists. Inappropriate radiofrequency ablation leads to scar-related electrical changes in the left and the right atria. We present a case of fractionated electrograms of the right atrium in a patient with previous radiofrequency ablations due to atrial fibrillation and atypical atrial flutter. PentaRay mapping catheter was used to identify the mechanisms of tachycardia precisely and to map fractionated electrograms. Key words: atypical atrial flutter, atrial fibrillation, right atrium substrate modification, catheter ablation, 3D mapping.
Аbay Bakytzhanuly1, Bakytzhan Bimbetov2, Omirbek Nuralinov1, Zhanasyl Suleymen1, Аyan Abdrakhmanov1, 1 Interventional arrhythmology department, JSC “National Scientific Cardiac Surgery Center”, Nur-Sultan, Republic of Kazakhstan; 2 RSE "Hospital of the Medical Center" of the Department of Affairs President of the Republic of Kazakhstan, Nur-Sultan, Republic of Kazakhstan.
1. Andrikopoulos G., Tzeis S., Vardas P.E. Invasive therapy for atrial fibrillation: recent developments in ablation, navigation and mapping technology // Heart. 2011. 2. Calkins H., Hindricks G., Cappato R., et al. HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation // Heart Rhythm. 2017;14(10):e275–e444. http://doi:10.1016/j.hrthm.2017.05.012 3. Hiram R., Naud P., Xiong F., Al-U'datt D., Algalarrondo V., Sirois M.G., Tanguay J.F., Tardif J.C., Nattel S. Right Atrial Mechanisms of Atrial Fibrillation in a Rat Model of Right Heart Disease // J Am Coll Cardiol. 2019 Sep 10;74(10):1332-1347. doi: 10.1016/j.jacc.2019.06.066. PMID: 31488271. 4. Platonov P.G. “Atrial fibrosis: an obligatory component of arrhythmia mechanisms in atrial fibrillation?” // Journal of geriatric cardiology: JGC vol. 14,4 (2017): 233-237. doi:10.11909/j.issn.1671-5411.2017.04.008 5. Phlips T., Taghji P., El Haddad M., Wolf M., Knecht S., Vandekerckhove Y., Tavernier R., Duytschaever M. Improving procedural and one-year outcome after contact force-guided pulmonary vein isolation: the role of interlesion distance, ablation index, and contact force variability in the 'CLOSE'-protocol // Europace. 2018 Nov 1;20(FI_3):f419-f427. doi: 10.1093/europace/eux376. PMID: 29315411. 6. Ting Yung Chang, Li Wei Lo, Abigail Louise D. Te et al. The importance of extrapulmonary vein triggers and atypical atrial flutter in atrial fibrillation recurrence after cryoablation: Insights from repeat ablation procedures // J Cardiovasc Electrophysiol. 2019; 30: 16-24. http://doi: 10.1111/jce.13741
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Bakytzhanuly А., Bimbetov B., Nuralinov O., Suleymen Zh., Abdrakhmanov А. Substrate modification of right atrium in a patient with scar-related atrial flutter // Nauka i Zdravookhranenie [Science & Healthcare]. 2021, (Vol.23) 3, pp. 165-170. doi 10.34689/SH.2021.23.3.020 Бакытжанулы А., Бимбетов Б., Нуралинов О., Сулеймен Ж., Абдрахманов А. Модификация субстрата правого предсердия у пациента с инцизионным трепетанием предсердий // Наука и Здравоохранение. 2021. 3(Т.23). С. 165-170. doi 10.34689/SH.2021.23.3.020 Бақытжанұлы А., Бимбетов Б., Нұралинов Ө., Сүлеймен Ж., Абдрахманов А. Инцизионды жүрекше дірілі бар науқаста оң жүрекше субстрат модификациясы // Ғылым және Денсаулық сақтау. 2021. 3 (Т.23). Б. 165-170. doi 10.34689/SH.2021.23.3.020