Left-sided atrial flutter originating in the coronary sinus after radiofrequency ablation of atrial fibrillation.
We describe a case of atypical atrial flutter presenting 1 year after radiofrequency ablation for atrial fibrillation (AF). Electrophysiologic study showed a reentry circuit involving the inferolateral aspect of the mitral annulus and the coronary sinus (CS); however, a mitral isthmus line did not terminate the arrhythmia. Participation of the proximal CS musculature in the circuit suggested a possible target for ablation. Radiofrequency energy applications from within the CS terminated the tachycardia. Mapping and ablation within the CS should be considered in patients with post-AF ablation arrhythmias, particularly when the mitral annulus appears to be involved in the tachycardia circuit.
Division of Cardiology, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD 21201, USA. ajimenez@medicine.umaryland.edu
Alejandro
A
Jimenez
Stephen R
SR
Shorofsky
Timm M
TM
Dickfeld
Rishi
R
Anand
Anastasios P
AP
Saliaris
Magdi
M
Saba
D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D001282:Atrial Flutter / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D054326:Coronary Sinus / Q000503:physiopathology* / Q000601:surgery*; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome