Cryoballoon ablation of atypical mitral isthmus-dependent left atrial flutter
- PDF / 197,988 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 50 Downloads / 279 Views
CASE REPORTS
Cryoballoon ablation of atypical mitral isthmus-dependent left atrial flutter Arash Aryana 1 & Maheer Gandhavadi 1 & Rohit Bhaskar 1 & Luigi Di Biase 2 Received: 9 September 2020 / Accepted: 19 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
An 87-year-old woman underwent pulmonary vein isolation (PVI) with concomitant posterior wall isolation (PWI) within the region of the pulmonary venous component (PVc), using a 28-mm cryoballoon (Arctic Front Advance; Medtronic, Minneapolis, MN), for the treatment of symptomatic persistent atrial fibrillation (a). Subsequently, the rhythm spontaneously converted into a clockwise mitral isthmusdependent left atrial flutter (cycle length: 240 ms), with the earliest activation noted on the distal coronary sinus (CS 1,2). It was decided to ablate the tachycardia using the available cryoballoon. A single 3-min cryoapplication delivered to the superior aspect of the anterior mitral isthmus (b, c), guided by intracardiac echocardiography (CARTOSound; Biosense
* Arash Aryana [email protected] 1
Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, CA, USA
2
Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
Webtster, Irvine, CA), resulted in cycle length wobble. The cycle length eventually stretched to 360 ms, prior to termination during a second 3-min cryoapplication delivered to the inferior aspect of the isthmus (d). An additional 4 cryoballoon applications were delivered along the lateral/inferolateral aspects of the mitral isthmus to achieve conduction block (e), as demonstrated by a proximal to distal activation in the coronary sinus atrial electrograms when pacing (asterisk) from within the left atrial appendage (f). During cryoapplications, the circular mapping catheter (Achieve; Medtronic) was placed across the mitral valve, unanchored. Care was taken not to occlude the valvular orifice. Stability during applications was maintained through cryo-adhesion.
J Interv Card Electrophysiol
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Data Loading...
