Radiofrequency Ablation of Atrial Flutter

A33-year-old man with cardiac and pulmonary sarcoidosis developed ventricular tachycardia managed with an implantable cardioverter-defibrillator and amiodarone therapy. Subsequently, episodes of atrial flutter triggered spurious therapies from the implantable cardioverter-defibrillator, and the patient underwent electrophysiological evaluation. Common atrial flutter (caudocranial septal and counterclockwise right atrial activation) was induced, with a cycle length of 270 ms. Entrainment with a postpacing interval equal to the flutter cycle length was demonstrated in the right atrial inferior isthmus (Figure 1A⇓), indicating that this region was part of the macroreentrant circuit. A steerable 7F quadripolar 4-mm-tip thermistor radiofrequency (RF) ablation catheter (EP Technologies, Inc) was used to make a line of RF lesions extending from the tricuspid annulus to the inferior vena cava until bidirectional isthmus conduction block could be demonstrated. Atrial flutter ended during RF current application (Figure 1B⇓). Subsequently, there was no recurrence of atrial flutter. However, progressive heart failure …