Abstract
Abstract 14913: Ultra High-Density Mapping of Peri-Mitral Atrial Flutter Reveals Epicardial Bridging of Endocardial Conduction Block
Circulation (New York, N.Y.), Vol.138(Suppl_1 Suppl 1), pp.A14913-A14913
11/06/2018
Abstract
IntroductionWe describe a case of perimitral atrial flutter following pulmonary vein isolation and endocardial linear mitral isthmus (MI) ablation. Ultra high resolution activation and voltage gradient mapping (VGM) revealed epicardial conduction in the coronary sinus bridging the endocarial isthmus line. Selective ablation of the epicardial bridging within the CS terminated tachycardia and created bidirectional block across the MI.MethodsA decapolar diagnostic catheter (6F, Webster CS, Biosense Webster, Diamond Bar, CA) placed in the distal coronary sinus near the epicardial mitral isthmus. High density endocardial activation and voltage gradient maps (VGM) of the left atrium were created using the IntellaMap Orionhigh density mapping catheter with the Rhythmia Mapping System (Boston Scientific, Cambridge, MA) during atrial tachycardia (AT).ResultsThe AT had a cycle length of 361ms. Activation and voltage maps containing 12,988 electrograms were created in tachycardia illustrated a peri-mitral atrial flutter utilizing an epicardial voltage bridge to conduct across the endocardial line of block (see Figure). Split potentials were observed on the coronary sinus catheter with continuous signals spanning these splits on CS electrodes 5-6. The ablation catheter was placed inside the coronary sinus and ablation at this site terminated tachycardia.Conclusions:Although mitral isthmus block may be obtained by endocardial ablation, refractory isthmus conduction with resulting persistent flutter may be secondary to epicardial bridging. This case report illustrates the utility of ultra high-density VGM and activation mapping for direct visualization of both endocardial and epicardial conduction across the MI.
Details
- Title: Subtitle
- Abstract 14913: Ultra High-Density Mapping of Peri-Mitral Atrial Flutter Reveals Epicardial Bridging of Endocardial Conduction Block
- Creators
- Steven Bailin - University of IowaHardik Doshi - University of IowaJames Arter - Internal Medicine, Boston Scientific, Cambridge, MAThein Aung - Internal Medicine, Univ of Iowa, Iowa City, IA
- Resource Type
- Abstract
- Publication Details
- Circulation (New York, N.Y.), Vol.138(Suppl_1 Suppl 1), pp.A14913-A14913
- Publisher
- by the American College of Cardiology Foundation and the American Heart Association, Inc
- ISSN
- 0009-7322
- eISSN
- 1524-4539
- Language
- English
- Date published
- 11/06/2018
- Academic Unit
- Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984361720802771
Metrics
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