Work

Pseudo-Conduction After Cavotricuspid Isthmus Ablation

Year: 2026

Type: article

Abstract: BACKGROUND: Bidirectional cavotricuspid isthmus (CTI) block is the procedural endpoint of typical atrial flutter ablation, but pseudo-conduction may mimic residual isthmus conduction. CASE SUMMARY: A 45-year-old man underwent CTI ablation for typical atrial flutter. After linear ablation, a short double-potential interval and simplified differential pacing suggested residual conduction near the inferior vena cava (IVC). Additional ablation at this region failed to change the activation pattern. High-density mapping ultimately confirmed complete CTI block, whereas rapid activation around the IVC reached the lateral right atrium early, creating a pseudo-residual conduction pattern. The patient had no complications and remained free from recurrence during 9-month follow-up. DISCUSSION: Rapid conduction around the IVC may confound conventional criteria for CTI block. TAKE-HOME MESSAGE: High-density mapping may help differentiate true residual conduction from pseudo-conduction and prevent unnecessary ablation.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2026.111015

Authors: Youmei Shen, Shumpei Mori, Xiang Xue, Hailei Liu, Minglong Chen

Institutions: Jiangsu Province Hospital, Nanjing Medical University, University of California, Los Angeles

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