title: Simplified progressive approach for the ablation of scar related atrial macroreentrant tachycardias.
abstract: BACKGROUND
  Radiofrequency ablation of scar related right atrial flutter is challenging. Long procedures, prolonged fluoroscopic times and high percentages of recurrences are of concern. We present a simple and progressive approach based on a single electroanatomic map of the right atrium.
  
  
  METHODS
  Twenty-two consecutive patients with atrial flutter and history of cardiac surgery were included. An electrophysiologic study was performed to define localization (left or right) and cavo-tricuspid isthmus participation using entrainment mapping. After a critical isthmus was localized, ablation was performed with an external irrigated tip catheter with a power limit of 30 W. Potential ablation sites were confirmed by entrainment.
  
  
  RESULTS
  The predominant cardiopathy was atrial septal defect. All arrhythmias were localized in the right atrium; mean cycle length of the clinical flutter was 274 ± 31 ms. Only 40% had cavo-tricuspid isthmus participation. None of the patients with successful ablation had recurrences after 13 ± 9.4 months of follow-up.
  
  
  CONCLUSIONS
  A progressive approach with only one activation/voltage CARTO(®) map of the atrium and ablation of all potential circuits is a highly effective method for ablating scar related macroreentrant atrial arrhythmias.
authors.affiliation: Electrocardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico, DF, Mexico. Electronic address: santiagonavat@hotmail.com.
authors.forename: Santiago
authors.initials: S
authors.lastname: Nava
authors.affiliation: Electrocardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico, DF, Mexico.
authors.forename: Pedro
authors.initials: P
authors.lastname: Iturralde-Torres
authors.affiliation: Electrocardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico, DF, Mexico.
authors.forename: Manlio F
authors.initials: MF
authors.lastname: Márquez
authors.affiliation: Electrocardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico, DF, Mexico.
authors.forename: Jorge
authors.initials: J
authors.lastname: Gómez-Flores
authors.affiliation: Electrocardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico, DF, Mexico.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Cline
authors.affiliation: Electrocardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico, DF, Mexico.
authors.forename: Luis
authors.initials: L
authors.lastname: Colin-Lizalde
authors.affiliation: Electrocardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico, DF, Mexico.
authors.forename: Diana
authors.initials: D
authors.lastname: Victoria
authors.affiliation: Electrocardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico, DF, Mexico.
authors.forename: Antonio G
authors.initials: AG
authors.lastname: Hermosillo
mesh_terms: D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D002648:Child; D002921:Cicatrix / Q000150:complications* / Q000601:surgery*; D005260:Female; D006325:Heart Atria; D006801:Humans; D008297:Male; D008875:Middle Aged; D013610:Tachycardia / Q000209:etiology* / Q000601:surgery*; D055815:Young Adult
keywords: Ablación; Ablation; Atrial tachycardia; CARTO(®); Flutter; Macroreentrant; Macrorreentrada; Mexico; México; Taquicardia auricular