Three-Dimensional (3D) Mapping and Catheter Ablation for Simultaneous Reverse Typical and Atypical Atrial Flutter: A Case Report

• Published in: Curēus (Palo Alto, CA) Vol. 15; no. 11; p. e48948
• Main Authors: El Ouartassi, Hajar, El Boussaadani, Badre, Faraj, Raid, Fellat, Ibtissam, Cherti, Mohamed
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 17.11.2023; Cureus
• Subjects: Ablation; Adenosine; Calcification; Cardiac arrhythmia; Cardiology; Cardiovascular disease; Case reports; Catheters; Circuits; Coronary vessels; Heart; Medical diagnosis; case report; catheter ablation; cavo-tricuspid isthmus; atrial flutter; 3d electroanatomic mapping
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.48948

Atrial flutter, a common cardiac arrhythmia, is characterized by rapid and regular atrial contractions that result in a characteristic sawtooth pattern on the electrocardiogram. It emerges due to the formation of reentrant electrical circuits within the atria, giving rise to structured, sawtooth-patterned atrial waves as observed on electrocardiography. We present the case of a 52-year-old female with a medical history of ankylosing spondylitis, dyslipidemia, and a previous surgical closure of an atrial septal defect. The patient developed a rare form of atrial flutter, characterized by two distinct mechanisms: a clockwise isthmus-dependent flutter and an atypical scar-related flutter around the atriotomy scar. In order to effectively address this complex condition, a successful ablation procedure was performed to target both mechanisms. This case report offers valuable insights into the complexities surrounding the diagnosis and treatment of a complex case characterized by the coexistence of multiple mechanisms of atrial flutter within a single patient. While catheter ablation has demonstrated improved success rates for typical and atypical atrial flutters when occurring in isolation, predicting the prognosis of complex cases continues to pose challenges.