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Case report of a double-wave re-entry atrial flutter in a patient with atrial cardiomyopathy.
Jacinto, Sofia; Portugal, Guilherme; Valente, Bruno; Cunha, Pedro; Oliveira, Mário.
Afiliación
  • Jacinto S; Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Centre, R. de Santa Marta 50, 1169-024 Lisbon, Portugal.
  • Portugal G; Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Centre, R. de Santa Marta 50, 1169-024 Lisbon, Portugal.
  • Valente B; Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Centre, R. de Santa Marta 50, 1169-024 Lisbon, Portugal.
  • Cunha P; Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Centre, R. de Santa Marta 50, 1169-024 Lisbon, Portugal.
  • Oliveira M; Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Centre, R. de Santa Marta 50, 1169-024 Lisbon, Portugal.
Eur Heart J Case Rep ; 8(6): ytae272, 2024 Jun.
Article en En | MEDLINE | ID: mdl-38863991
ABSTRACT

Background:

Double-wave macrore-entry is a rare mechanism of atrial tachycardia with limited documentation in the literature. We present a three-dimensional documentation of a double-wave 'typical' atrial flutter in a patient with extensive atrial cardiomyopathy. Case

summary:

A 78-year-old female with a history of atrial cardiomyopathy and dual-chamber pacemaker for sinus node disease presented with palpitations and incessant atrial flutter. Electrophysiological study revealed a regular tachycardia with a cycle length (TCL) of 230 ms, with proximal to distal coronary sinus (CS) activation. Three-dimensional mapping identified two independent wavefronts circulating the cavotricuspid isthmus (CTI), each with a TCL of 460 ms. Cavotricuspid isthmus ablation resulted in conversion into a distinct tachycardia with left atrial roof origin. Linear ablation in this location slowed the TCL to 435 ms with concentric CS activation and another CTI dependent atrial flutter was mapped, this time with only one wavefront of activation. Further ablation with a second, more lateral, line in the CTI led to tachycardia interruption. Given the extensive atrial scarring and high arrhythmic recurrence risk, atrioventricular node ablation was performed.

Discussion:

Double-wave re-entrant tachycardias were primarily observed in experimental models, precipitating acceleration of ventricular and supraventricular tachycardias via extrastimulation. In our case, there is documentation of a spontaneous double-wave of activation around the CTI, representing the first documented double-wave 'typical' atrial flutter. Unlike other cases in the literature, the two wavefronts were equidistant, which resulted in a regular tachycardia with TCL that was half of the single-wave cycle length. Three-dimensional propagation mapping was essential to visualize the two distinct wavefronts.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Eur Heart J Case Rep Año: 2024 Tipo del documento: Article País de afiliación: Portugal Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Eur Heart J Case Rep Año: 2024 Tipo del documento: Article País de afiliación: Portugal Pais de publicación: Reino Unido