SPC365

Atypical right atrium flutters

Session: Sessão de Posters 41 - Taquiarritmias supraventriculares
Speaker: Joao Santos Fonseca

Congress: CPC 2024
Topic: C. Arrhythmias and Device Therapy
Theme: 04. Arrhythmias, General
Subtheme: 04.6 Arrhythmias, General – Clinical
Session Type: Cartazes
FP Number: ---
Authors: Joao Santos Fonseca; Ana Beatriz Garcia; Ana Margarida Martins; Catarina Simões Oliveira; Joana Brito; Nelson Cunha; Afonso Nunes Ferreira; Gustavo Lima da Silva; Luís Carpinteiro; Nuno Cortez-Dias; Fausto J. Pinto; João de Sousa
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Introduction: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Atypical right Atrial Flutter (AFl) are uncommon tachycardias, mostly documented in patients with previous structural cardiopathy or previous ablation lesions. </span></span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Purpose: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">We aim to describe the mechanism of right atypical AFl submitted to ablation.</span></span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Methods: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Single center<strong> </strong>cohort of patients (pts) submitted to atypical right AFl from 2015 to 2022. Patients were consecutively selected from a pool of pts referred to atypical AFl mapping and ablation.</span></span></span></span></p>

<p>&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Results: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">From a total of 185 pts referred for atypical flutter ablation a right atypical AFl was documented in 10 pts. Only 3 patients had no documentation of structural cardiopathy or previous ablation, 3 pts had a severe congenital anomaly, 1 a surgical corrected ASD, 1 had dilated cardiomyopathy and was submitted to surgical CRT leads extraction, the remaining </span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">2 had been submitted to previous cavotricuspid isthmus (CTI) ablation.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Regarding the patients without a previous medical history, one had a localized reentry in the superior vena cava, another a localized reentry in the anterior border of a spontaneous lateral scar, and the other a macro reentrant dual loop, constituted with a lower-loop and clockwise CTI. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">All the other AFl were macro-reentrant tachycardia - 3 single-loops, 2 dual-loops and 1 four-loop.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Low voltage was most frequently localized in the lateral wall (7/10 pts), which was spontaneous in 3 pts and incisional in the others. All these pts presented at least one loop scar related. A loop dependent on the inferior vena cava was found in 2 pt and a gap from a previous ablation in 1 pt.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">In one pt, after termination of the 1<sup>st</sup> flutter, a 2<sup>nd</sup> new flutter was remapped, with the documentation of single loop dependent on a gap from a previous inter-cava line.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Acute successful conversion was achieved in all patients, although one patient had an early recurrence and was submitted to AV node ablation.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Table 1 summarizes the&nbsp;characteristics of the 10 cases described.</span></span></span></span></p>

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<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Conclusion:</span></span></strong></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Right atypical AFl are infrequent tachycardias, more commonly associated with previous structural cardiopathy or previous ablation lesions. Through this descriptive work we aimed to leverage community expertise on this rare pathology.</span></span></span></span></p>