Electrophysiological evidence of right atrial epicardial connections in a case with recurrent common atrial flutter

Masaya Shinohara; Tadashi Fujino; Hosei Kikushima; Ryo Wada; Shintaro Yao; Kensuke Yano; Katsuya Akitsu; Takanori Ikeda

doi:10.1111/pace.14958

Electrophysiological evidence of right atrial epicardial connections in a case with recurrent common atrial flutter

Pacing Clin Electrophysiol. 2024 Mar 2. doi: 10.1111/pace.14958. Online ahead of print.

Authors

Masaya Shinohara¹, Tadashi Fujino², Hosei Kikushima¹, Ryo Wada¹, Shintaro Yao¹, Kensuke Yano¹, Katsuya Akitsu¹, Takanori Ikeda²

Affiliations

¹ Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
² Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan.

PMID: 38430486
DOI: 10.1111/pace.14958

Abstract

The majority of the cavotricuspid isthmus (CTI) region consists of discretely arranged muscle bundles separated by connective tissue. Heterogeneity in the anatomic arrangement of the muscle bundles results in differences in the endocardial and epicardial activation patterns. We present a case of recurrent atrial flutter (AFL) despite the presence of a complete endocardial CTI block. We found epicardial-endocardial breakthrough (EEB) sites on the right atrial high septum. In addition, the epicardial excitation confirmed by endocardial activation mapping was detected as far-field potentials. Radiofrequency ablation was performed at the EEB site. No AFL has recurred for 12 months after the present procedure.

Keywords: Octaray catheter; common atrial flutter; epicardial fiber; high-density 3-dimensional mapping.

Publication types

Case Reports