657 RECURRENT TYPICAL ATRIAL FLUTTER UNDERGOING ABLATION IN A JUVENILE PATIENTS’ SERIES

Abstract

Abstract Aims Cavotricuspid isthmus ablation is a routine procedure in electrophysiology laboratories. It is mainly performed as treatment for cavotricuspid isthmus-dependent atrial flutter, which is rare in young patients without structural heart disease. Safety and efficacy data regarding this procedure in such patients are scarce. In this case series we present the clinical characteristics and procedure related outcomes of 3 juvenile patients without overt structural heart disease who underwent cavotricuspid isthmus ablation in our Hospital for recurrent typical atrial flutter. Methods and Results Of the 1217 flutter ablation procedures performed in our Hospital from 2003 to 2022, 3 were on juvenile, otherwise healthy patients. The median patient age was 19.3 years old. All of them had a history of recurrent paroxysmal typical atrial flutter, which was initially terminated with electrical cardioversion. Given the young age no pharmacological prophylaxis was initiated, but on the subsequent recurrence we decided for an ablative strategy. Echocardiography and/or MRI excluded structural heart disease. One of them had experienced flutter induced tachycardiomyopathy, while one underwent previous cavotricuspid isthmus ablation with subsequent arrhythmia relapse. All the procedures were conducted using standard electrophysiology equipment successfully, without significant complications. Baseline electric characteristics of cavotricuspid isthmus were recorded and block of conduction was confirmed using standard protocols. Conclusion Recurrent cavotricuspid isthmus-dependent atrial flutter in young Patients without structural heart disease is exceptionally rare, and ablation is seldom performed. In this case series we present 3 patients with such characteristics, and in whom cavotricuspid isthmus radiofrequency ablation was successfully performed.