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Ablation of Postsurgical Atrial Flutter Guided by Concealed Fragmented Potentials

Year: 2025

Type: article

Abstract: BACKGROUND: Postsurgical atrial flutter constitutes a significant portion of atypical atrial flutter. Its activation sequence is complex and exhibits significant individual variation. CASE SUMMARY: A 76-year-old woman with a history of atrial septal defect repair was admitted for atrial flutter. Although initial mapping suggested a focal atrial tachycardia originating from the left anterior wall, complex signal identification revealed previously overlooked prolonged low-amplitude fragmented potentials within the map. This unveiled a macro-re-entrant circuit around the right superior pulmonary vein. After radiofrequency ablation at the critical fragmented potential site, sinus rhythm was restored. DISCUSSION: In this case, the final mapping diagnosis markedly differed from the initial interpretation, highlighting the critical importance of precisely identifying the key slow conduction zone. TAKE-HOME MESSAGES: Tachycardias after cardiac surgery are predominantly atypical atrial flutter. Detailed mapping and meticulous analysis are paramount for successful ablation of complex tachycardias.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.105789

Authors: Bangjiaxin Ren, Mingyang Tang, Xianjin Hu, Rui Zeng

Institutions: Sichuan University, West China Hospital of Sichuan University, Chengdu Fifth People's Hospital, Chengdu University of Traditional Chinese Medicine

Language: English

Topic: Cardiac Arrhythmias and Treatments

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850