“Pseudo”-AV block and right atrial electrical disconnection complicating ablation for typical atrial flutter

Abstract

avoid ablation within the pulmonary veins, as well as near the esophagoatrial interface. Segmental ostial ablation guided by a 10-pole circular mapping catheter was then performed after circumferential ablation to ensure electrical isolation of each vein. There were no complications. At 6 months, the patient has remained free of AF as assessed by symptoms and periodic Holter monitoring. Conclusions: CT imaging used in conjunction with a non-fluoroscopic navigation system is a new and important tool for AF ablation. By providing a highly detailed anatomic representation of the left atrium, pulmonary veins and esophagus, CT imaging serves to verify the accuracy of NavX-generated geometry. Regions of interest, such as the pulmonary vein ostia, the left atrial roof, the esophago-atrial interface and the isthmus between the left atrial appendage and the left superior pulmonary vein, can be more accurately defined, potentially resulting in a more effective and precise ablation while avoiding serious complications, such as pulmonary vein stenosis and esophago-atrial fistulas.