Localizing Left Atrial Flutter Using the Advisor™ HD Grid Mapping Catheter, Sensor Enabled™

Abstract

A 75-year-old woman with a history of prior ablation for persistent atrial fibrillation was referred for atrial tachycardia ablation. Based on her history and surface electrocardiogram P-wave morphology, a reentrant left atrial tachycardia was suspected. Isochronal late-activation mapping (ILAM) was performed during coronary sinus pacing using the AdvisorTM HD Grid Mapping Catheter, Sensor EnabledTM and EnSiteTM NavXTM Precision cardiac mapping system, revealing a deceleration zone along the posterior left atrium with highly fractionated local signals (Figures 1A and 1D). Following the induction of atrial tachycardia, local activation time mapping supported the diagnosis of left atrial reentrant tachycardia (Figure 1B and Video 1). Entrainment was attempted; however, the tachycardia terminated repeatedly with catheter placement. Radiofrequency ablation was performed at this site along with isolation of the posterior wall. The pulmonary veins remained isolated from the previous procedure. The tachycardia was noninducible postablation, with no clinical recurrence at three months of follow-up.