Demonstration of an adjacent conduction gaps-derived left atrial and pulmonary vein flutter by high-density mapping
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KeywordsLeft atrial and pulmonary vein flutter High-density mapping Pulmonary vein isolation Conduction gap Catheter ablation
A 66-year-old woman underwent catheter ablation of atrial tachycardia (AT) that occurred after pulmonary vein (PV) isolation and roof line ablation for persistent atrial fibrillation. High-density activation mapping showed activation propagating from the anterosuperior left atrium (LA) to the block line of the roof and through the interatrial septum to the posterior LA (Fig. 1). Further mapping unveiled residual right superior PV (RSPV) electrograms, where activation propagated from the posterosuperior LA to the RSPV through a first conduction gap (CG) and from the RSPV back to the anterosuperior LA through a second CG (Fig. 1). A single radiofrequency application at the first CG terminated the tachycardia, and additional radiofrequency applications at the second CG resulted in RSPV isolation. Thereafter, any AT was non-inducible.