Atypical left atrial flutter after intraoperative radiofrequency ablation of chronic atrial fibrillation: Successful ablation using three-dimensionalelectroanatomic mapping

Left Atrial Flutter Ablation. Curative treatment of chronic atrial fibrilla tion (AF) remains a challenging task for electrophysiologists. Eliminating the initiating triggers by focal radiofrequency ablation in a subset of pat ients with paroxysmal AF and modifying the maintaining substrate by perform ing linear lesions within the left atrium in patients with prolonged episod es of AF are among the alternative approaches for management of these patie nts. Recently, a new intraoperative treatment procedure aimed at eliminatin g left atrial anatomic "anchor" reentrant circuits by induction of contiguo us lesions using radiofrequency energy under direct vision was introduced. However, atypical left atrial butter may occur during follow-up after intra operative ablation of AF, These arrhythmias most likely are due to disconti nuities in linear lesions; therefore, they can be successfully mapped and a blated in a subsequent percutaneous catheter ablation procedure, We report and discuss the case of a patient who underwent successful intraoperative a blation of chronic AF, but who developed atypical left atrial flutter posto peratively, Three-dimensional nonfluoroscopic electroanatomic mapping revea led a gap in the linear lesion line connecting the left upper and right upp er pulmonary vein orifices. Ablation at the exit site of the breakthrough w as successful.