Ablation of atypical atrial flutter in a patient after radiotherapy for adenocarcinoma of the right lung using the Coherent CARTOPRIME™ module of the CARTO system

Abstract

Atrial flutter (AFl) is the second most frequent persistent supraventricular arrhythmia, after atrial fibrillation (AF). In the most common type of AFl the circuit is localized in the right atrium and it is cavotricuspid isthmus dependent, what is termed typical. In atypical AFl the wave front does not go around the tricuspid annulus. It is often associated with prior cardiac surgery or ablation for AF, including linear lesions or defragmentation, where iatrogenic scar serves as the electrophysiologic substrate for reentry. The number of cases, when the circuit is related to a spontaneous lowvoltage zone, in the absence of any previous atrial procedures is limited. The reasons behind it might be a significant heart disease, such as mitral valve dysfunction, impaired diastolic function or hypertension, which lead to fibrosis and functional regions of slow or no conduction (SNO, slow or no conduction zone. However, it is still not well understood how electrically silent areas occur in patients without risk factors mentioned above. We present a case report of a patient who suffered damage to the left atrial wall during radiotherapy treatment, and atypical AFl was induced on the basis of the resulting scar.