Influence of common zones of low-amplitude activity on the mechanism and treatment of atrial arrhythmias

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Abstract

Background: The treatment of left atrial flutter is a problem that requires a deep understanding of the underlying complex mechanism of arrhythmia. Although a considerable experience exists already in understanding the mechanisms underlying atrial flutter after ablation or surgery, little is known about atypical forms of atrial flutter in patients who have not previously undergone ablation or other cardiac surgery.

Clinical case description: We present a clinical case of interventional treatment of a patient with atypical atrial flutter who had not previously undergone surgical or interventional heart surgery. This clinical observation demonstrates the role of common zones of low-amplitude activity on the mechanism and treatment of atrial arrhythmias. Widespread areas of low-amplitude activity in the left atrium can create barriers to the propagation of excitation, which can cause atypical atrial flutter.

Conclusion: When performing a surgical intervention, high-density mapping will help to visualize the mechanism of this arrhythmia. Understanding the mechanism of atypical atrial flutter will help to minimize the RF exposure during the treatment.

About the authors

Elizaveta V. Dedukh

A.V. Vishnevsky National Medical Research Center of Surgery

Author for correspondence.
Email: dedukh.elizaveta@mail.ru
ORCID iD: 0000-0002-4799-7456
SPIN-code: 4433-7258

Graduate Student

Russian Federation, 27, Bolshaya Serpukhovskaya street, Moscow, 117997

Elena A. Artyukhina

A.V. Vishnevsky National Medical Research Center of Surgery

Email: artelena.71@mail.ru
ORCID iD: 0000-0001-7065-0250

M.D., Ph.D., Dr. Sci. (Med.)

Russian Federation, 27, Bolshaya Serpukhovskaya street, Moscow, 117997

References

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Supplementary files

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2. Fig. 1. An intraoperative electrogram, where I–III, aVL, aVR, aVF are electrocardiogram leads, CS (1–10) — is recording of electrograms from an electrode placed in the coronary sinus. Atypical atrial flutter with a cycle length of 290 ms is being registered.

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3. Fig. 2. A high-density voltage map of the left atrium, built using the Carto 3 navigation mapping system. Red areas correspond to the endocardial signal amplitude lower than 0.2 mV, purple areas — to the amplitude higher than 0.5 mV.

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4. Fig. 3. A 3D electroanatomical map of the left atrium (LA), built during atypical atrial flutter with a cycle length — of 290 ms: а — activation map of the LA, blue arrows indicate the course of excitation propagation; б — anatomical reconstruction of the LA, pink dots are sites of radiofrequency application; в — LA voltage map. Visualization of the consistency of linear damage after radiofrequency ablation.

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5. Fig. 4. An intraoperative electrogram, where I–III, aVL, aVR, aVF, V1–V6 are electrocardiogram leads, ABL (1–4) is recording of ablation electrode electrograms, CS (1–10) is recording of electrograms from the electrode placed in the coronary sinus. An increase in the tachycardia cycle length from 290 ms to 360 ms during radiofrequency ablation is seen.

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6. Fig. 5. A 3D electroanatomical map of the left atrium (LA), built during atypical atrial flutter with a cycle length of 360 ms: а — activation map of the LA, blue arrows indicate the course of excitation propagation; б — activation map of the LA, pink dots are sites of radiofrequency application; в — an intraoperative electrogram, where I–III, aVL, aVR, aVF, V1–V6 are electrocardiogram leads, ABL (1–4) is recording electrograms of the ablation electrode, CS (1–10) — recording electrograms from the electrode placed in the coronary sinus. See the sinus rhythm restoration.

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7. Fig. Timeline: Chronology of the disease development, key events and prognosis for patient M. Note. ЭКГ — electrocardiogram; ХМ-ЭКГ — daily monitoring of the electrocardiogram.

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Copyright (c) 2021 Dedukh E.V., Artyukhina E.A.

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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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