Termination and Block of Typical Atrial Flutter as Shown by Advisor™ HD Grid Technology
DOI: 10.19102/icrm.2021.120118S
SRI SUNDARAM, MD, FHRS,1 DAN ALYESH, MD,1 and WILLIAM CHOE, MD1
1South Denver Cardiology Associates, Littleton, CO, USA
 |
Download PDF |
|
KEYWORDS. Atrial flutter, arrhythmia, supraventricular tachycardia, ablation.
Dr. Sundaram and Dr. Choe are consultants for Abbott and have received honoraria for lectures and training. The other author reports no conflicts of interest for the published content.
Address correspondence to: Sri Sundaram, MD, FHRS. Email: sris@southdenver.com.
A 65-year-old male patient with no comorbidities presented with palpitations. A diagnosis of typical atrial flutter was established based on a sawtooth pattern on the electrocardiogram with negative flutter waves in the inferior leads and positive flutter waves in V1. The atrial flutter was found to be refractory to medical therapy with β-blockers; thus, the decision to proceed with ablation was made.
In Figure 1, the high-density grid catheter (Advisor™ HD Grid Mapping Catheter, Sensor Enabled™) is displayed in a caudal view of the right atrium. Intracardiac electrograms are shown on the bottom. Following the activation sequence of white → red → orange → yellow → green → light blue → dark blue → purple, the counterclockwise mechanism is presented in Figure 1A. With an additional ablation lesion at the ablation catheter tip, the tachycardia was terminated and the activation pattern changed from counterclockwise to approaching the cavotricuspid isthmus from a clockwise direction, indicating that block had been achieved; this can be observed with the change in activation pattern in Figure 1B. Note that, the earliest color, white, is now seen on the septal side of the cavotricuspid isthmus (Video 1).
|
Figure 1: A: The Advisor™ HD Grid and ablation catheters are displayed in a caudal view of the right atrium. Intracardiac electrograms are shown on the bottom. Following the activation sequence of white → red → orange → yellow → green → light blue → dark blue → purple, the rhythm was confirmed as typical counterclockwise flutter. B: The tachycardia terminated and normal sinus rhythm resumed. Note that the color scheme reversed into a clockwise pattern with this achievement, which indicates that block has been achieved as the activation pattern has changed. |
|
Video 1: The cavotricuspid isthmus (CTI) is displayed in a right atrial caudal view. The Advisor™ HD Grid catheter is on the ablation line and reveals the activation sequence to be progressing in a counterclockwise pattern across the CTI with the color scheme of white ⇾ red ⇾ orange ⇾ yellow ⇾ green ⇾ light blue ⇾ dark blue ⇾ purple. The electrograms are displayed on the bottom of the video. Initially, the rhythm was typical atrial flutter. However, as the ablation catheter delivered a lesion, the flutter terminated and normal sinus rhythm resumed. With the change in rhythm, the activation pattern on the high-density grid also changed to a clockwise pattern as demonstrated by the change in color scheme. |
The patient remained well and in normal sinus rhythm six weeks after ablation.
All published case image reviews within the print supplement and ePub version have been independently submitted and developed exclusively by the authors. Each published case image review within the print and ePub version has successfully undergone the double-blind peer-review process. The opinions presented herein are specific to the featured physicians and are for informational purposes only. The results from any case study may not be predictive of results for all patients. These case study reviews are not intended to provide medical advice or to take the place of written law or regulations. The distribution of the print supplement and ePub version is supported through a grant from: Abbott
|
Case Image Review Compendium:Featuring: AdvisorTM HD Grid Mapping Catheter, Sensor EnabledTM |
 |