4/1/2023 0 Comments Chronic atrial flutter icd 10Nevertheless, thorough examination of the signals of the bottom of the LA showed double signals directly opposite to the entire CS: one sharper signal simultaneous to the recorded signal in CS (encircled in Figure 1) and in addition highly fractionated signals, which presented a sequence proximal to distal (see stars and arrows in Figure 1). A focal mechanism of the tachycardia was primarily assumed. The entrance of the tachycardia to the RA was at the CS ostium. In the LA it seemed that the tachycardia was centrifugal propagating from a focal exit in the inferolateral mitral annulus with highly fractionated signals. An ultrahigh density activation mapping from both LA and RA was performed. The decapolar catheter had one large sharp signal per cycle on each bipole Figure 1. The P-Wave was biphasic negative in II, III, aVF, positive in V1-V2 and isoelectric in I. A roof line led to abrupt cycle length prolongation to 270msec with CS propagation distal to proximal. Low voltage was documented in the roof of LA. The pulmonary veins were persistently isolated. LAT mapping and post pacing interval (PPI) mapping revealed a roof dependant atrial flutter with a “figure of 8” propagation around both pulmonary vein pairs. Paul, MN) was created using a high-density mapping catheter (HD Grid catheter SE, Abbott) with support from a steerable long sheath (Agilis, Abbott). An activation map of the left atrium (NavX Ensite Precision, Abbott, St. A notch filter was applied for every catheter. A steerable decapolar catheter (Inquiry, Abbott, spacing 2-5-2) was introduced into the coronary sinus by the femoral vein and showed a “chevron” pattern. The procedure was performed under conscious sedation. We performed a new electrophysiological study upon admission. A PVI-only procedure was performed four years ago. The flutter waves were monophasic positive in II, III, aVF and V1-V2, negative in aVL and isoelectric in I. The electrocardiogram showed atypical flutter with atrial cycle length (CL) of 240msec. Case PresentationĪ 77-year-old female patient presented with shortness of breath and tachycardia of 125bpm. We herein report a rare case of a peri-CS atrial flutter in a female patient after pulmonary vein isolation (PVI) four years ago and roof line ablation due to roof-dependent atypical flutter during the same procedure. However, this kind of tachycardia has only been reported once. The CS musculature with its connections to RA and LA and the adjacent myocardium of LA can serve as substrate for a macroreentrant circuit without utilizing other atrial areas. The coronary sinus often is a critical part of various forms of left atrial macroreentrant tachycardias, mostly of common perimitral flutter, and biatrial tachycardias, such as large circuits around both mitral and tricuspid valves or biatrial flutter with perimitral circuit using only the right atrial septum. The connections to the LA can vary from one or two up to a wide continuum. As already known from several anatomical and invasive studies, the coronary sinus (CS) musculature connects to the right atrium (RA) as well as the left atrium (LA) forming electrical interatrial connections. In recent years, flutter circuits utilising epicardial structures have been a focus of interest, as their occurrence has become more frequent after endocardial catheter ablation and understanding the mechanisms of complex macroreentrant tachycardias has become deeper through high resolution mapping. Atrial Flutter articles Catheter Ablation articles Coronary Sinus Flutter articles Macroreentrant Tachycardia articles Article Details 1.
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