title: Uncommon atrial flutter originating in the left atrioventricular groove: emergence after successful catheter ablation for a left concealed accessory pathway.
abstract: This report describes a 49-year-old male with concealed Wolff-Parkinson-White syndrome in whom a true uncommon atrial flutter suddenly emerged 2 weeks after successful catheter ablation of a left-sided accessory pathway. The earliest atrial activation during the atrial flutter was recorded at the posterolateral mitral annulus 2 cm proximal to the previous successful ablation site for the accessory pathway. Two applications of radiofrequency (RF) current directed at the supravalvular mitral annulus could not terminate the atrial flutter. A subsequent delivery of RF current directed at the subvalvular annulus, where a local fragmented potential preceded the earliest atrial activation, eliminated the atrial flutter.
authors.affiliation: First Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: M
authors.initials: M
authors.lastname: Hayashi
authors.forename: Y
authors.initials: Y
authors.lastname: Miyauchi
authors.forename: N
authors.initials: N
authors.lastname: Kawaguchi
authors.forename: H
authors.initials: H
authors.lastname: Ogura
authors.forename: H
authors.initials: H
authors.lastname: Saitoh
authors.forename: T
authors.initials: T
authors.lastname: Ino
authors.forename: H
authors.initials: H
authors.lastname: Atarashi
authors.forename: H
authors.initials: H
authors.lastname: Kishida
authors.forename: H
authors.initials: H
authors.lastname: Hayakawa
mesh_terms: D000818:Animals; D001282:Atrial Flutter / Q000503:physiopathology* / Q000628:therapy*; D001283:Atrioventricular Node / Q000503:physiopathology; D017115:Catheter Ablation; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D014927:Wolff-Parkinson-White Syndrome