Roof‐dependent atrial flutter with epicardial conduction pathway masked by left atrium posterior wall debulking ablation

Abstract

Abstract Roof‐dependent atrial flutter (AFL) is a major tachyarrhythmia rotating in the left atrium (LA). Here, we describe a case of roof‐dependent AFL during atrial fibrillation ablation. LA posterior wall (LAPW) debulking ablation was performed before the induction. Atrial tachycardia (AT) was induced by burst pacing, and the 3D mappings showed a focal pattern from the LA inferior area. The post‐pacing interval from the roof and bottom line corresponded to the AT cycle length. The LAPW debulking ablation masked roof‐dependent AFL due to the lack of endocardium potentials in the LAPW. We report that roof‐dependent AFL connected by epicardium fibers.

Keywords

• atrial fibrillation
• ethanol infusion
• posterior wall isolation
• roof‐dependent atrial flutter
• septo‐pulmonary bundle
• vein of Marshall