![]() ![]() ![]() ABA strategies for AFL treatment obtain high procedural success rates with reliable termination of most macro-reentrant tachycardias. In electroanatomical mapping (EAM) voltage maps are collected simultaneously annotating local electrical signal amplitudes, but these maps are generally not used to determine ablation strategy in AFL ablation cases. High-Density 3D-Mapping is usually applied to obtain activation maps by gathering local activation time (LAT) during ongoing reentrant tachycardia for ABA strategies. Establishing a durable bidirectional line of block remains challenging in this anatomically based ablation (ABA) strategy and incomplete transmural ablation lesions often leave proarrhythmogenic substrate behind, thus promoting further atrial tachyarrhythmias,. A “classical” mitral isthmus line from the left inferior pulmonary vein (LIPV) to the posterior mitral annulus or an anterior mitral isthmus line from the left superior pulmonary vein (LPSV) to the anterior mitral annulus in perimitral AFL or a roof line from the LSPV to the right superior pulmonary vein (RSPV) for roof-dependent AFL is applied, thereby creating a line of block within the reentrant circuit,. The common approach to treat AFL is the 3D-mapping system guided identification of the macro-reentrant circuit and introduction of an ablation line that connects the central anatomical structure with a second non-conducting anatomical structure. The central non-conductive anatomical structure, the center of the macro-reentry in AFL, is typically the mitral valve (MV) or the septal or lateral pulmonary veins (PV), resulting in perimitral, roof-dependent around the lateral PV and roof-dependent around the septal PV as the most common reentrant circuits in left atrial AFL. In contrast to typical atrial flutter, which can be treated with high success rates by ablation of an anatomically well-defined structure, the cavotricuspid isthmus (CTI), identification of the AFL defining re-entry mechanism is much more challenging. Since catheter ablation for the treatment of atrial fibrillation (AF) has become standard of care also in aging patients with the number of procedures constantly rising, incidence of AFL is continuously increasing,. Atypical atrial flutter (AFL) comprises macro-re-entrant tachycardias of the left and/or right atrium, the majority occurring in the left atrium.ĪFL typically occurs in elderly patients with previous cardiac surgery, atrial ablation procedures, mitral valve defects or structural heart disease. Atrial flutter describes atrial macro-reentrant tachycardias. ![]()
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