Journal of Arrhythmia (Jun 2012)

Irregular atrial flutter following pulmonary vein isolation for persistent atrial fibrillation

  • Tadanobu Irie, MD,
  • Yoshiaki Kaneko, MD, PhD,
  • Tadashi Nakajima, MD, PhD,
  • Masaki Ota, MD,
  • Toshimitsu Kato, MD,
  • Takafumi Iijima, MD,
  • Mio Tamura, MD,
  • Takashi Iizuka, MD,
  • Akihiro Saito, MD, PhD,
  • Toshio Ito, MD,
  • Masahiko Kurabayashi, MD, PhD

DOI
https://doi.org/10.1016/j.joa.2011.11.004
Journal volume & issue
Vol. 28, no. 3
pp. 192 – 195

Abstract

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A 65-year-old man with a history of refractory paroxysmal atrial fibrillation (AF) underwent catheter ablation for persistent AF lasting 2 months. AF was not terminated after complete isolation of the 4 pulmonary veins (PV). Instead, it was transformed to a sustained atrial tachyarrhythmia with beat-to-beat variability in the atrial cycle length. A 12-lead electrocardiogram during tachycardia showed negative flutter-like waves in the inferior leads. Entrainment pacing along the tricuspid annulus confirmed the diagnosis of irregular cavotricuspid isthmus (CTI)-dependent typical atrial flutter (AFL). Linear ablation of the CTI terminated AFL and restored sinus rhythm.

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