High-density Grid Catheter Localizes Eccentric Atrial Flutter to the Left Superior Pulmonary Vein Ridge Through Extreme Isochronal Compression

DOI: 10.19102/icrm.2021.120115S

DIPAK SHAH, MD,¹ ADAM RACETTE,² and JESSICA WROBEL²

¹Ascension Providence Hospital, Mobile, AL, USA

²Abbott, Chicago, IL, USA

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KEYWORDS. High-density grid, high-density mapping, left atrial flutter, left atrial ridge, localized reentry.

Mr. Racette and Ms. Wrobel are employees of Abbott. The other author reports no conflicts of interest for the published content.
Address correspondence to: Dipak Shah, MD. Email: dipak.shah@ascension.org.

A 75-year-old woman with hypertension and symptomatic drug-refractory paroxysmal atrial fibrillation (AF) elected to undergo AF ablation. Pulmonary vein isolation was performed with a wide antral circumferential ablation. As her esophagus was bordering the left-sided ostia and our left-sided ablation lesion set was more antral, we were also able to isolate her posterior wall. Rapid atrial pacing postablation induced an eccentric atrial flutter (AFL) with a cycle length of 260 ms. Activation mapping with the EnSite Precision™ mapping system with the Advisor™ HD Grid Mapping Catheter, Sensor Enabled™ catheter revealed localized reentry at the left atrial appendage/left superior pulmonary vein ridge. At the critical location, significant compression was seen on the activation color map with a fractionated signal with a duration of 190 ms, essentially encompassing two-thirds of the tachycardia cycle length (Figure 1 and Video 1). Ablation at this region terminated the AFL within a few seconds and the AFL was no longer inducible postablation. This case demonstrates the use of the high-resolution Advisor™ HD Grid catheter using high-density wave technology to analyze orthogonal electrograms at a single location, thereby facilitating rapid identification and treatment of AFL.