Left atrial and pulmonary vein flutter associated with double electrical connections after a lung transplantation

A 53-year-old man with a history of bilateral lung transplantation (LT) underwent electrophysiological testing of supraventricular tachycardia (SVT). Activation map revealed that the activation propagated from the right PV (RPV) cuff to the left atrium (LA) through a first conduction gap located at the superior aspect of the RPV cuff and from the LA back to the RPV cuff through a second conduction gap located at the inferior aspect of the RPV cuff (Panel-A), suggesting that the SVT should be a figure-of-8 type macroreentrant atrial flutter (AFL) associated with 2 conduction gaps between the donor RPV cuff and recipient LA. A single irrigated radiofrequency application was delivered at the first conduction gap with a fractionated mid-diastolic potential, resulting in prolongation of the SVT cycle length followed by termination of the SVT (Panel-B). A couple of irrigated radiofrequency applications were delivered at the second conduction gap, resulting in an isolation of the RPV cuff.
Source: Europace - Category: Cardiology Source Type: research