Dynamic Activation Changes during Complex Atypical Atrial Flutter in a Previously Untreated Atrium.
Wei-Chieh Lee, Pei-Chieh Huang
✦ AI-curated · Sources linked
Case in brief
A 76-year-old woman with hypertension and paroxysmal atrial fibrillation presented with drug-refractory atypical atrial flutter (AFL) in a previously untreated atrium. Electrophysiological study revealed a CTI-related AFL, which transformed through multiple activation patterns during ablation. Despite initial conduction block, the tachycardia persisted due to dynamic changes in coronary sinus activation. Epicardial ablation in the coronary sinus successfully terminated the arrhythmia.
What made this case unusual
The case highlights the rare occurrence of multiple sequential transformations of atypical AFL activation patterns within a single procedure in a previously untreated atrium.
Diagnostic / clinical pearl
Clinicians should consider the potential involvement of epicardial coronary sinus musculature in atypical AFL when standard ablation techniques fail.
Why it matters
This case underscores the complexity of atypical AFL and the need for awareness of dynamic activation changes that may complicate management.