12/9/2023 0 Comments Atrial flutter ablation endoscopyIn other words, none of these modalities can tell the interventionalist where the ostium is, but on the contrary, it is the electrophysiologist who must tell the mapping system where the ostium is located. Thus, since even an anatomist cannot discern where the ostium of the pulmonary vein is, the proceduralist should always temper any information provided from advances in technology including merging of CT data or echocardiographic data to electroanatomic maps, etc. Arrow points to pulmonary vein stenotic areas.Īnatomically, there is no specific structure that defines the pulmonary vein ostium (there are no valves or ridges, etc.). Pulmonary vein stenosis will not result if ablation delivery is kept proximal to the pulmonary vein ostium. The lower images represent three-dimensional reconstructions. Note the abrupt stenosis just into the pulmonary vein. ![]() However, when the circuit can be proven to traverse through any two electrically inert structures, ablation can be done across that structure and bidirectional block used as an endpoint for the ablation line.Ĭomputerized-tomographic images illustrating pulmonary vein stenosis. An important lesson from the anatomy of the CVTI-dependent flutter circuit is that a slow zone as such may not necessarily be found. When approaching an atypical flutter, electrophysiologists generally use a combination of entrainment and activation mapping to identify the critical or slow zone of the circuit and ablate at that site. The isthmus, however, may be transected by placement of a patch or conduit, and in some instances, the isthmus may be between the mitral annulus and the IVC (for example, in patients with cc-TGA - congenitally corrected transposition of the great vessels). ![]() The ability to correlate anatomic lessons that underlie difficult CVTI ablation can be useful in atypical situations.ĬVTI-dependent flutter is one of the most common macroreentrant tachycardias that occur in patients with congenital heart disease following surgery. Atypical Flutter and Atypical Situations Where CVTI-Dependent Flutter Occurs
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