Case Of Atrial Flutter Research Articles

A Case of Atrial Flutter diagnosed at the Family Health Center

A Case of Atrial Flutter diagnosed at the Family Health Center

Abstract 16255: Unraveling the Complex Interplay: Atrial Flutter in a Patient With Prior Double Outlet Right Ventricular Repair

Introduction: Double Outlet Right Ventricle (DORV) is a rare complex congenital heart disease (CHD) in which both the great arteries arise predominantly or entirely from the right ventricle. It is one of the rare CHD lesions with a prevalence of about 0.9%. These patients have complex anatomy, which increases their risk of recurrent arrhythmias. We present a challenging case of Atrial Flutter (AFL) in a patient with DORV. Case: A 31-year-old male with a history of DORV repair presented with palpitations and chest pain for 2 days. His heart rate (HR) was 240 bpm. EKG showed AFL with variable block [Figure 1]. Labs were unremarkable. The patient remained in AFL with HR above 120 bpm despite receiving diltiazem and adenosine. Considering his underlying complex anatomy, ablation was deferred, and the patient was cardioverted to sinus rhythm [Figure 1]. A loop monitor was placed and was started on flecainide with outpatient follow-up at a higher centre. Discussion: Infundibulotomy, removal of obstructive muscle bundles, and a patch to widen the passageway from the right ventricle to the pulmonary arteries are all steps in DORV repair. These surgeries result in scar tissue, an akinetic right ventricular outflow tract, and pulmonary valve insufficiency. Reentrant tachycardias may form due to surgical scars. In DORV patients, Atrial tachyarrhythmias have undesirable outcomes resulting in congestive heart failure, stroke, and mortality. Antiarrhythmics and cardioversion are the cornerstones of managing AFL in patients with DORV due to increased failure rates of catheter ablation. Conclusion: This case illustrates persistent atrial arrhythmias more likely due to DORV repair, resulting in cardiac remodeling. The abnormal anatomy makes localization of irritated ectopic foci and ablations ineffective and difficult.

Atrial Flutter After Radiofrequency Ablation for Barrett's Esophagus: A Case Report.

BACKGROUND Barrett's esophagus (BE) is a metaplastic change in the normal esophageal squamous epithelium and is a well-recognized precursor of esophageal adenocarcinoma (EAC). Nowadays, focal radiofrequency ablation is a valid technique for BE treatment by inducing a superficial and focal thermic destruction of metaplastic tissues. According to the literature, the most frequent patient-related adverse events of this procedure are esophageal iatrogenic stenosis, mucosal laceration or perforation of the esophagus, chest pain, and odynophagia/dysphagia. Postoperative heart rhythm abnormalities have been reported very rarely. CASE REPORT A 74-year-old patient with HE was treated by radiofrequency ablation (RFA) with the Barrx™ catheter system. He had 2 symptomatic episodes of atrial flutter in the immediate postoperative period requiring an external electrical cardioversion to induce a return to sinus cardiac rhythm. After atrial flutter ablation, 2 more radiofrequency procedures were performed, without adverse events. A laparoscopic Nissen fundoplication was carried out with complete endoscopic and histologic eradication of BE after 12-month follow-up. To the best of our knowledge, this is the first reported case of atrial flutter after esophageal RFA. Different mechanisms acting on an anatomic predisposing substrate can potentially play a role in starting atrial flutter, and include inflammation, autonomic activation, and myocardial injury. CONCLUSIONS The occurrence of this new type of adverse effect could potentially modify indications and postoperative monitoring of RFA treatment for BE. Endoscopists should know the possibility of this procedural complication in high-risk patients and they should propose alternative techniques or implement close cardiac monitoring in the postoperative period.

Fetal Atrial Flutter: Early Detection and Treatment

Fetal atrial flutter (AF) can occur with structurally normal hearts or congenital heart disease, including atrioventricular septal defect, hypoplastic left heart syndrome, pulmonary atresia, and Ebstein's malformation. 1 It is important to detect fetal AF early and treat it appropriately. We present a case of fetal AF that was treated timely, resulting in no associated complications. The infant was born by cesarean section at a gestational age of 37 weeks with an Apgar score of 9 and 9. The birth weight was 2860 grams. The antenatal history was positive for fetal tachycardia.

Back to the basics: A case of atrial flutter?

Back to the basics: A case of atrial flutter?

АНАЛИЗ ГОСПИТАЛИЗИРОВАННОЙ ЗАБОЛЕВАЕМОСТИ БОЛЕЗНЯМИ СИСТЕМЫ КРОВООБРАЩЕНИЯ НАСЕЛЕНИЯ СТАРШЕ ТРУДОСПОСОБНОГО ВОЗРАСТА РОССИЙСКОЙ ФЕДЕРАЦИИ

Significance: The fact of population ageing, including the associated rise in cardiovascular diseases, leads to a higher care seeking by people of post-working age and, as a result, an increase in the number of hospital admissions. The analysis of admission rate makes it possible to evaluate advanced cases and severity of conditions associated with the admission to hospital. The purpose of the study is to analyze dynamics in changes in the indicator of admission rate for diseases of the circulatory system among post-working age population in the Russian Federation. Material and methods. The composition of post-working age patients with diseases of the circulatory system and individual nosologies discharged from hospital was analyzed according to the federal statistical observation form No. 14 “Information on activities of departments of medical organizations providing inpatient care” for the period 2010-2021 (divided into two periods due to the changed retirement age). Research methods included: statistical, analytical. Results. In 2010-2019 in the Russian Federation, the highest increase in admission rate was registered for other heart diseases - 2.4 times including a 2.64-fold rise in fibrillation and atrial flutter cases, an 80.8% increase in past myocardial infarction, a 25.9% increase in hypertensive heart disease, a 20.2% rise in cerebrovascular diseases, including a 28.6% rise in other cerebrovascular diseases. Over a decade, the admission rate for all diseases increased from 269.7 to 294.1 per 1000 post-working age population (women aged 55+, men aged 60+) (by 9.1%), including a rise in diseases of the circulatory system from 105.3 to 107.5 per 1000 population of the corresponding age (by 2.1%). The share of admissions for diseases of the circulatory system among post-working age population in the structure of all diseases decreased from 38.9% to 36.5%. The admission rate among post-working age population in 2020-2021 increased from 77.6 to 78.35 per 1000 population of the corresponding age (women aged 56+, men 61 +). Conclusion: In 2010-2019, the admission rate for diseases of the circulatory system increased by 2.1%. The share of the discharged patients admitted for emergency care due to diseases of the circulatory system increased from 43.65 to 53.0%. During the second period under study (2020-2021), the indicator of admission for diseases of the circulatory system increased by almost 1.0% with a slight decrease in the share of the discharged patients admitted for diseases of the circulatory system from 60.2 to 58.7%.

Clinical characteristics and outcomes of atrial flutter in neonates.

Atrial flutter is an uncommon arrhythmia that can cause severe morbidity, including heart failure and even death in refractory cases. This study investigated the clinical characteristics, treatment, and long-term outcomes of patients with neonatal atrial flutter and its association with heart failure. We retrospectively reviewed atrial flutter cases observed in our center between 1999 and 2021 and analyzed the clinical characteristics, treatment, and recurrence according to the presence of heart failure. The study comprised 15 patients with atrial flutter, with median bodyweight and gestational age of 2.7 kg, 37+4 weeks, respectively. Twelve patients were diagnosed with atrial flutter on the first day of life. The median atrial and ventricular rates were 440/min, 220/min, respectively. Four patients exhibited congestive heart failure. Episodic recurrence was noted in five patients and occurred at a higher rate in patients with congestive heart failure (p = 0.004). Antiarrhythmic drugs for maintenance treatment were administered more often in patients with heart failure (p = 0.011). Initial treatment included direct current cardioversion (n = 9), digoxin (n = 4), and observation (n = 2). Four patients treated with cardioversion experienced recurrence during the neonatal period, and none of those treated with digoxin experienced recurrence. The median follow-up duration was 7 years, during which no atrial flutter recurrence was evident. Neonates with congestive heart failure had a higher recurrence of atrial flutter. Direct current cardioversion is the most reliable treatment for neonatal atrial flutter, whereas digoxin may be a viable treatment option in refractory and recurrent cases.

Vernakalant for Cardioversion of Recent-Onset Atrial Fibrillation in the Emergency Department: The SPECTRUM Study

Introduction: Intravenous vernakalant is a therapeutic option for symptomatic, recent-onset atrial fibrillation (AF). This secondary analysis from the large SPECTRUM study assessed the safety and effectiveness of vernakalant when used in the emergency department setting (ED group) or in an inpatient hospital setting (non-ED group). Methods: This post hoc analysis of the international, observational, post-authorization SPECTRUM study included 1,289 and 720 recent-onset AF episodes in adults in the ED and non-ED groups, respectively. Safety endpoints included the evaluation of pre-defined health outcomes of interest (HOIs) and other serious adverse events (SAEs) during vernakalant treatment and during the first 24 h after the last infusion. Effectiveness endpoints comprised the rate of successful vernakalant cardioversion, the time from the start of the vernakalant infusion to cardioversion, and the length of hospital stay. Data were analysed using descriptive statistics. Results: The safety profile of vernakalant was similar in the ED and non-ED groups. In the ED group, 12 pre-defined HOIs were reported in 11 patients (0.9%); all but one occurred within 2 h after start of the first infusion. These events comprised nine significant bradycardia cases, of which one was associated with transient hypotension and three with sinus arrest, and 2 cases of atrial flutter with 1:1 conduction. Five other SAEs were reported. All patients with vernakalant-related events recovered without sequelae. No Torsade de Pointes, ventricular fibrillation, or deaths occurred. Successful cardioversion was reported in 67.8% (95% confidence interval: 65.2–70.4) and 66.4% (62.5–70.1) of episodes, with a median time to conversion of 11.0 and 10.0 min in the ED and non-ED groups, respectively. Patients had a median length of hospital stay of 7.4 h and 17.1 h in the ED and non-ED groups, respectively. Conclusion: Intravenous vernakalant was well tolerated with similar cardioversion rates in patients treated in the ED or non-ED setting and does not require admission to a coronary care unit or intensive care unit. First-line treatment with vernakalant could allow an early discharge in patients with recent-onset AF treated in the ED.

Atrial flutter without structural heart disease in pediatrics: a retrospective review of cases in the Hospital Infantil Miguel Servet, Zaragoza, Spain.

Atrial flutter is a rare condition in pediatrics that usually occurs as a late complication after surgery for congenital heart diseases, although it can also appear in structurally normal hearts. We conducted a retrospective study of cases of atrial flutter with no structural heart disease diagnosed in a pediatric population (between 0 and 15 years of age) during 2015-2021 in a tertiary hospital. A total of seven cases were diagnosed, with a clear predominance of males (6/7). Of the seven patients, five debuted in the perinatal period: two were diagnosed at 20 and 36 hours of life, and three, prenatally. Among these perinatal cases, more than half (3/5) were preterm. The treatment was electrical cardioversion. The evolution was satisfactory in these cases, and there were no tachycardias in their subsequent development. In contrast, when the debut occurred at a later age (5-7 years), it was associated with channelopathy (Brugada syndrome and catecholaminergic polymorphic ventricular tachycardia), and electrical ablation of the ectopic focus was required due to poor response to pharmacological treatment. This study confirms the low incidence of this pathology in pediatrics and the benignity and good prognosis of neonatal flutter in most cases. The prognosis worsens when atrial flutter is diagnosed in older children, and the probability of concomitant associated heart disease increases.

Percutaneous edge-to-edge repair for systemic tricuspid valve regurgitation in patients with congenital heart disease: the first descriptive cohort

Abstract In patients with congenital heart diseases (CHD) systemic tricuspid regurgitation (STR) is frequent. Here, we report our experience with percutaneous edge-to-edge repair (PETER) in a series of 12 CHD patients with STR using the MitraClip system. Twelve patients (median age = 35 years, 83% males) with severe STR (ccTGA (n=5), asTGA (n=3), SV (n=4)), at high-risk for surgical treatment, gave informed consent for treatment using PETER. The XTR MitraClip device (Abbott, Santa Clara, CA) was used. At baseline, 7/12 patients were in NYHA functional class ≥ III. Standard femoral venous access was successfully used in 10/12 patients. In SV patients, the systemic valve was accessed directly through the right atrium (n=2), after a Fontan conduit puncture (n=1), or after direct atrial surgical access (n=1). In TGA patients, either transseptal (ccTGA patients, n=4) or transbaffle (asTGA patients, n=3) puncture was performed (4). Mitraclip devices were successfully implanted in 11/12 patients (Figure 1). One procedural complication was reported for a patient with SV in whom a septal leaflet rupture occurred following clip release, leading to severe STR; the patient died from refractory cardiac failure one week later. Peri-procedural complications included one case of left femoral vein injury and one case of atrial flutter treated by catheter ablation. After a median follow-up of 12-months (range 1–25) following device implantation, no death had occurred. The patients had significant reduction in STR (from severe to moderate in 10/11 patients) and clinically improved (10/11 patients were in NYHA class I or II). To conclude, percutaneous edge-to-edge therapy of STR in CHD patients is feasible, safe and effective to reduce STR and SRV dilatation. This reduction is associated with a significant clinical improvement. Funding Acknowledgement Type of funding sources: None.

C20 IMPACT OF TELEMEDICINE SERVICES DURING THE COVID–19 PANDEMIC

Abstract During the Italian national lockdown (11/3 to 4/5/2020), the COVID–19 epidemic caused a shift of hospital resources towards the management of the COVID+ patient; hospitals saw a progressive drop of admissions for acute myocardial infarction and arrhythmias. In order to verify the role of Telemedicine in this context, we compared 6104 ECGs recorded by 5000 pharmacies, with the 17280 ECGs of the same period of 2019, evaluated and stored in the telemedicine platform of Health Telematic Network (HTN), in collaboration with the Department of Cardiology of the University of Brescia, Federfarma and Istituto Superiore di Sanità. Chest pain was the reason for examination in 298 patients (4.88%) vs 402 (2.33%) in 2019 (+109.86%). Of these, 118 were in Lombardy, (39.50% of the total), 36 in the province of Brescia (30.50%) and 28 in the province of Bergamo (23.73%). 8 ECGs showed a STEMI picture, (2.68%), compared with 7 STEMIs (1.74%) detected in 2019 (+ 54.17%). All of these patients were referred urgently to the emergency department. We detected Atrial Fibrillation in 344 patients (5.64%), vs 393 (2.27%) in 2019, (+ 40.25%); 32 cases of Atrial Flutter (0.52%), vs 25 (0.14%) detected in 2019 (+ 26.92%). Finally, we found paroxysmal supraventricular tachycardia in 8 cases (0.13%), vs 6 cases (0.03%) detected in 2019(+ 23.07%). During the lockdown period, 384 patients (6.29%) were referred to the emergency department for symptomatic tachyarrhythmia, vs 424 patients (3.47%) in 2019(+ 55.16%). In Lombardy, 194 cases of tachyarrhythmia were reported in territorial pharmacies (about 50.52% of the total in Italy), 93 in the Brescia area (47.94%), 50 in the Bergamo area (25.77%). Conclusions: a high number of patients with cardiovascular symptoms preferred to refer to territorial pharmacies during the COVID–19 blast. Telemedicine allowed patients with STEMI to access hospitals quickly, avoiding a serious diagnostic delay; a significant proportion of accesses to local pharmacies for chest pain occurred in the region most affected by the COVID–19 outbreak; the service also allowed to refer to the hospital only patients with clinically relevant tachyarrhythmias, avoiding delay of care and inappropriate accesses. This underlines how the telemedicine network provided by pharmacies can become an important resoruce for the citizen, supporting the services of the Italian National Health System.

Result and technique consideration of radiofrequency catheter ablation of tachycardia in patients with dextrocardia

Patients with tachycardia, in the context of pre-existing dextrocardia, could benefit from catheter ablation. However, anatomical complexities hinder effective conduct of this procedure. We aimed to retrospectively summarize the clinical characteristics and the safety and efficiency, and recommended the technique considerations. Twenty-one cases from 19 patients with tachycardia and dextrocardia, who underwent catheter ablation between 2009 and 2021, were enrolled. All patients underwent echocardiography and computed tomography (CT) to confirm the anatomical malformations. Transseptal puncture was guided by fluoroscopy or intracardiac echocardiography when left atrial access was necessary and the ablation process was guided by three-dimensional (3D) mapping. Six cases exhibited situs solitus while nine cases exhibited situs inversus. Fourteen cases had atrial fibrillation, seven had atrial flutter, and two had atrioventricular reentrant tachycardia (AVRT); two cases had combined atrial fibrillation and atrial flutter. Acute success was achieved in 18 cases (85.7%, 18/21). The 3D mapping system was not employed in the three cases which failed. During long-term follow-up (20.71 ± 21.86 months), eight cases (72.7%, 8/11) of atrial fibrillation with dextrocardia successfully attained sinus rhythm. None of AVRT cases had recurrence. Half of the atrial flutter cases with dextrocardia, especially those with a history of surgical correction for cardiac malformations, underwent recurrence. One case had cardiac tamponade. Catheter ablation for tachycardia patients with dextrocardia is safe, efficient, and feasible. It is imperative to integrate echocardiography, cardiac computer tomography, and 3D mapping, and apply 3D reconstruction to facilitate the success of catheter ablation.

Anaesthetic and Perioperative Management of Elderly Female with Post Covid ARDS with Comorbities Undergoing Emergency Laparotomy for Obstructed Umbilical Hernia

Elderly female with chronic hypertension, known case of atrial flutter on rate control medication who recently treated for COVID-19 pneumonia on oxygen support(PFR=190) came to emergency room with complaints of abdominal mass and pain associated with vomiting, not passing stools. Diagnosed to have obstructed umbilical hernia with extensive secondary bacterial pneumonia with ARDS (ASA-4E). COVID-19 RTPCR test negative. Taken up for emergency laparotomy under combined spinal and epidural anaesthesia (CSEA). Post operatively patient was managed in intensive care unit for 5days with oxygen, invasive lines, vasopressor support and epidural infusion. Post covid patients presenting for emergency surgery requires evaluation of surgical illness and post covid sequels like oxygen dependency, cytokine storm, secondary bacterial infection, ARDS, lung fibrosis renal and liver dysfunction. Atrial flutter in perioperative period may lead to haemodynamic instability and thromboembolic events resulting in significant morbidity and mortality. Laparotomy in these patient is challenge. Needs better analgesia perioperative period to prevent further respiratory deterioration.

Atrial flutter in newborns

Objective. To describe a case of atrial flutter in a newborn.Results. The child in the maternity hospital was found to have a heart rhythm disorder of the type: atrial flutter, constant form. Examination revealed an atrial septal defect and an increase in the level of natriuretic peptide. Subsequently, the child was diagnosed with atrial flutter, constant form. NK 0-1. Open oval window. Treatment with drugs from the group of antiarrhythmics, antioxidants and cardiac glycosides made it possible to avoid pronounced hemodynamic disorders.Conclusion. The presented case demonstrates that timely diagnosis and medical correction prevent possible complications.

Atrial Flutter Mechanism Detection Using Directed Network Mapping.

Atrial flutter (AFL) is a common atrial arrhythmia typically characterized by electrical activity propagating around specific anatomical regions. It is usually treated with catheter ablation. However, the identification of rotational activities is not straightforward, and requires an intense effort during the first phase of the electrophysiological (EP) study, i.e., the mapping phase, in which an anatomical 3D model is built and electrograms (EGMs) are recorded. In this study, we modeled the electrical propagation pattern of AFL (measured during mapping) using network theory (NT), a well-known field of research from the computer science domain. The main advantage of NT is the large number of available algorithms that can efficiently analyze the network. Using directed network mapping, we employed a cycle-finding algorithm to detect all cycles in the network, resembling the main propagation pattern of AFL. The method was tested on two subjects in sinus rhythm, six in an experimental model of in-silico simulations, and 10 subjects diagnosed with AFL who underwent a catheter ablation. The algorithm correctly detected the electrical propagation of both sinus rhythm cases and in-silico simulations. Regarding the AFL cases, arrhythmia mechanisms were either totally or partially identified in most of the cases (8 out of 10), i.e., cycles around the mitral valve, tricuspid valve and figure-of-eight reentries. The other two cases presented a poor mapping quality or a major complexity related to previous ablations, large areas of fibrotic tissue, etc. Directed network mapping represents an innovative tool that showed promising results in identifying AFL mechanisms in an automatic fashion. Further investigations are needed to assess the reliability of the method in different clinical scenarios.

Тахиаритмия у новорожденных. Клинический случай трепетания предсердий у новорожденного

Актуальность. Тахиаритмии — это наиболее опасное нарушение ритма у новорожденных и детей грудного возраста. Редкой формой тахиаритмии, не характерной для новорожденных, является трепетание предсердий (ТП). ТП у новорожденных встречается с частотой 1 : 50 000 и составляет 3 % от всех нарушений ритма у новорожденных. Цель заключается в исследовании тахиаритмии новорожденных на примере клинического случая трепетания предсердий у новорожденного. Материалы и методы. В этой статье был рассмотрен клинический случай сложного нарушения ритма у новорожденного мальчика, а именно: трепетание предсердий 2 : 1, 3 : 1 с рецидивирующими приступами пароксизмальной наджелудочковой тахикардии, частыми желудочковыми экстрасистолами и пониженной сократимостью миокарда. Для исследования трепетания предсердий были использованы следующие методы: ЭКГ, 2D допплер-ЭхоКГ. Результаты. Медикаментозное лечение данного нарушения ритма состояло в следующем: АТФ в/в болюсно, повторно — неэффективно, инфузия кордарона 15 мг/кг/сут, седация. В связи с нарастанием сердечной недостаточности и низкой сократительной способностью миокарда была добавлена инотропная терапия (дигоксин 20 мкг/кг). В результате синусовый ритм был восстановлен в течение суток. Продлена инфузия кордарона в дозе 10 мг/кг/сут в течение 5 дней с переходом на 5 мг/кг/сут. Таким образом, в динамике по данным ЭхоКГ: уменьшились размеры камер сердца, внутрисердечных аномалий не было обнаружено. Кровоток в нисходящем отделе аорты пульсирующий, улучшилась сократительная способность миокарда: ФВ возросла — 45–50–62–66 %. Более того, на ЭКГ в динамике наблюдалось восстановление синусового ритма с ЧСС 130 уд/мин, без признаков гипертрофии миокарда и нарушений проводимости. Выводы. В нашем случае лечения эпизода ТП новорожденного —восстановление синусового ритма — достигнуто путем медикаментозной терапии. Альтернативным методом лечения ТП у новорожденных является синхронизированная электрическая кардиоверсия 0,5–1,0 Дж/кг [5, 6].

Association between human immunodeficiency virus serostatus and the prevalence of atrial fibrillation.

Atrial fibrillation (AF) leads to increased risk for stroke. Human immunodeficiency virus (HIV) is associated with cardiovascular disease (CVD), although it is unclear if HIV is associated with AF. The purpose of this study was to evaluate the association between HIV serostatus and the prevalence of AF in the Multicenter AIDS Cohort Study.A cross sectional study was conducted among 1674 HIV-infected (HIV+) and uninfected (HIV–) men who completed resting 12-lead electrocardiograms, and/or ambulatory electrocardiogram monitoring. Multivariable logistic regression was used to evaluate the association between AF, defined as the presence of either AF or atrial flutter, and HIV+ serostatus. Associations were adjusted for demographic variables, and then also for CVD risk factors.HIV+ men were younger than HIV– men (median 55.5 vs 61.7 years, P < .001) and were more frequently African-American (30.5% vs 17.8%, P < .001). Most HIV+ men (81%) had undetectable viral load. The age and race adjusted prevalence of AF was 3.0% in HIV+ and 3.3% in HIV– men. There was only 1 case of AF among African-American men. There were no associations between AF and HIV serostatus after adjusting for demographic factors (odds ratio 0.76; 95% CI 0.37 to –1.58; P = .47) or after further adjustment for CVD risk factors (odds ratio 0.84; 95% CI 0.39 to –1.81; P = .66).We found no association between HIV and AF in this cohort in which viral replication among the HIV+ men is generally suppressed. The overall prevalence of AF was low and was rare in African-American men.

Unusual Presentation of Atrial Flutter With Slow Ventricular Response

Atrial flutter is usually associated with tachycardia with a ventricular rate of 150 beats per minute. Less commonly, it may be associated with a slow ventricular response (SVR). This is typically seen in patients taking atrioventricular (AV) nodal blocking agents such as beta-blockers. In the absence of these drugs, atrial flutter with SVR may suggest intrinsic AV nodal disease, electrolyte disturbances, or atrial disease. We present a case of atrial flutter with SVR in a patient who was not receiving AV nodal blocking agents.

The effect of patient characteristics to the acute procedural success and long term outcome of atrial tachycardia and atrial flutter cases undergoing catheter ablation

Objective: In the present study we aimed to demonstrate clinical characteristics, predictors of procedural success and long term recurrence of atrial tachyarrhythmia patients undergoing catheter ablation (CA). Patients and Methods: Consecutive patients who had undergone CA due to an atrial tachyarrhythmia in a single centre arrhythmia unit between 2012 – 2020 were screened. Predictors of procedural success and recurrence were analysed by logistic regression. Results: Study population consisted of 299 consecutive patients (95 [31.8 %] atrial tachycardia, 204 [68.2 %] atrial flutter cases);163 ( 54.5 % ) were male; median age was 54 ( IQR; 42-64). Median follow up was 330 (IQR; 90 – 810) days. Atrial flutter patients were older and had more co-morbidities. Acute procedural success rate was 82.1 % vs. 77.0 % (p= 0.313) and recurrence was 9.3 % vs. 21.6 % (p=0.022) in atrial tachycardia (AT) and atrial flutter (AFL) cases respectively. History of valvular or congenital heart disease surgery, left atrium diameter and age were found to be independent predictors of failed ablation, recurrence and post-procedural atrial fibrillation. Conclusion: Age, left atrium diameter, valvular or congenital heart disease surgery are independent predictors for acute procedural success, recurrence and post-procedural atrial fibrillation in AT and AFL patients who undergo catheter ablation.

A Man with Unexplained Cause of Rapid Regular Wide QRS Complex Tachycardia: An Unusual Case Report of Atrial Flutter

Objective: To report an unusual case of atrial flutter with 1:1 atrioventricular (AV) conduction with unclear precipitating factors. Case Report: A 67-year-old Thai male patient presented with diarrhea and palpitation. The electrocardiogram showed a rapid regular wide QRS complex tachycardia (WCT). The tachycardia was spontaneously slow down during saline infusion. The atrial flutter with 2:1 AV conduction was demonstrated. The diagnosis of regular WCT was atrial flutter with 1:1 AV conduction. The precipitating cause could not be identified. The catheter ablation was successfully performed under EnSite Precision Cardiac Mapping System. The atrial flutter was suddenly terminated during catheter ablation along cavotricuspid isthmus. The patient remained sinus rhythm after eight months. Conclusion: The present case was an unusual case of atrial flutter with 1:1 AV conduction with unclear precipitating factors. Although some possible causes were demonstrated, clear precipitating causes in the present patient should be investigated in the future. Keywords: Atrial flutter with 1:1 AV conduction, Catheter ablation, Regular wide QRS complex tachycardia, Supraventricular tachycardia, Ventricular tachycardia