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• W2171776731 abstract "A 54-year-old man was admitted to our hospital for an episode of atypical chest pain associated with palpitations and dizziness. A surface 12-lead electrocardiogram showed the typical features of a counterclockwise cavotricuspid isthmus (CTI)–dependent atrial flutter with an average ventricular heart rate of 80 beats/min and a left bundle branch block QRS complex morphology. Acute myocardial infarction was ruled out. A transthoracic 2-dimensional echocardiogram performed the day after the hospitalization revealed a severe impairment of the left ventricular ejection fraction with a mild mitral regurgitation. Coronary angiography did not reveal any coronary artery stenosis or abnormality. An electrophysiological study confirmed the diagnosis of CTI-dependent right atrial flutter, and a linear radiofrequency ablation of the CTI was performed with restoration of sinus rhythm and demonstration of bidirectional block. For this purpose, a 7-Fr quadripolar deflectable catheter (Biosense-Webster) with an 8-mm tip was used. Remarkable was the fact that during the electrophysiological study there had been a constant documentation of high impedance on the ablation catheter when it was dragged from the tricuspid annulus to the border of the inferior vena cava. The impedance increase evidenced during the ablation was at first glance not completely understood, and it was associated with a decrease in power delivery. Although a right atrial angiography was not performed and no clots were found on the tip of the ablation catheter at the end of the procedure, a low-flow state around the catheter (probably due to a concave CTI anatomy, to crevices between pectinate muscles, or to the impairment of the left ventricular systolic function) was considered a suitable hypothesis for the decrease in power but not enough to explain the increase in impedance, which remained unexplained. The limitation of the power delivered by the ablation catheter concomitant with the above-described impedance increase was overcome with a slight lateralization of the ablation line. Within the 6 months after the ablation, although medical therapy was maximized, the patient was admitted 2 times for acute heart failure. Cardiac resynchronization therapy was then proposed to the patient. Before the implantation procedure, a standard electrocardiogram-gated contrast-enhanced 64-slice cardiac computed tomography of the heart was performed to assess the coronary venous anatomy (Figure 1). Panel A shows a frontal view of the heart. Panel B shows a frontal hollow view of the heart. Panel C represents the diaphragmatic 3-dimensional view of the heart (AO = aorta; CS = coronary sinus; CT = crista terminalis; FO = fossa ovalis; LA = left atrium; LAA = left atrial appendage; LV = left ventricle; RA = right atrium; RAP = right atrial pouch; RV = right ventricle)." @default.
• W2171776731 created "2016-06-24" @default.
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• W2171776731 date "2011-04-01" @default.
• W2171776731 modified "2023-09-27" @default.
• W2171776731 title "Abnormal right atrial pouch in a patient with heart failure and cavotricuspid isthmus-dependent atrial flutter" @default.
• W2171776731 cites W1995845168 @default.
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• W2171776731 doi "https://doi.org/10.1016/j.hrthm.2010.02.030" @default.
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