Late atypical atrial flutter after ablation of atrial fibrillation.
Cardiac surgery for structural heart disease (often involving the left atrium) and radiofrequency catheter ablation of atrial fibrillation have led to an increased incidence of regular atrial tachycardias, often presenting as atypical flutters. This type of flutter is particularly common after pulmonary vein isolation, especially after extensive atrial ablation including linear lesions and/or defragmentation. The authors describe the case of a 51-year-old man, with no relevant medical history, referred for a cardiology consultation in 2009 for paroxysmal atrial fibrillation. After failure of antiarrhythmic therapy, he underwent catheter ablation, with criteria of acute success. Three years later he again suffered palpitations and atypical atrial flutter was documented. The electrophysiology study confirmed the diagnosis of atypical left flutter and reappearance of electrical activity in the right inferior pulmonary vein. This vein was again ablated successfully and there has been no arrhythmia recurrence to date. In an era of frequent catheter ablation it is essential to understand the mechanism of this arrhythmia and to recognize such atypical flutters.
Serviço de Cardiologia, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal. Electronic address: ana_rakel_ferreira@hotmail.com.
Raquel
R
Ferreira
Serviço de Cardiologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
João
J
Primo
Serviço de Cardiologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
Luís
L
Adão
Serviço de Cardiologia, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal.
Anabela
A
Gonzaga
Serviço de Cardiologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
Helena
H
Gonçalves
Serviço de Cardiologia, Centro Hospitalar do Tâmega e Sousa, Amarante, Portugal.
Rui
R
Santos
Serviço de Cardiologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
Paulo
P
Fonseca
Serviço de Cardiologia, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal.
José
J
Santos
Serviço de Cardiologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
Vasco
V
Gama
D001281:Atrial Fibrillation / Q000601:surgery*; D001282:Atrial Flutter / Q000209:etiology*; D017115:Catheter Ablation / Q000009:adverse effects*; D006325:Heart Atria; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011667:Pulmonary Veins / Q000601:surgery; D012086:Reoperation
Ablação percutânea de fibrilhação auricular; Atypical atrial flutter; Catheter ablation of atrial fibrillation; Flutter auricular atípico; Re-ablation; Re-ablação