![]() ![]() Using a contiguous linear ablation line across the anterior roof and posterior left atrial wall, the four PVs and the posterior left atrial wall were electrically isolated en bloc. ![]() The four pulmonary veins (PV) were found to be moderately active electrically. Three-dimensional electroanatomic mapping was performed with the assistance of the Nav-X mapping system (St. A circular mapping catheter and a roving catheter were inserted into the left atrium. Double transseptal access was obtained using the standard Brockenbrough assembly. In the beginning, a duodecapolar catheter was inserted into the coronary sinus (CS) with bipoles 9 and 10 situated just inside the os. Dronedarone was discontinued for five half-lives prior to the procedure. After an extensive discussion of treatment options as well as their risks and benefits, she elected to undergo radiofrequency (RF) ablation. E-mail: Case presentationĪ 60-year-old female with a history of hypertension and diabetes presented with symptomatic persistent atrial fibrillation (AF) that was refractory to treatment with dronedarone. Manuscript received July 2, 2016, Final version accepted August 16, 2016.Īddress correspondence to: Robert Kim, MD, Assistant Professor of Medicine, University of Florida Health, Section of Cardiac Electrophysiology, 655 West 8th Street, 5th Floor, Jacksonville, FL 32209. The authors report no conflicts of interest for the published content. Complete atrioventricular block, perimitral flutter, persistent atrial fibrillation, radiofrequency ablation. It may be an under-recognized complication of the extensive atrial substrate ablation procedure. This case illustrates the need for awareness of regional anatomy and the precaution that has to be taken during RF ablation near this area. We present a delayed case of complete AV block complicating an acutely successful RF ablation of persistent AF. Anatomically, the septal mitral isthmus is located in close proximity to the left atrioventricular (AV) septum. However, some challenging cases require additional ablation at adjunctive sites such as the septal mitral isthmus, anterior left atrial wall, or intravascular coronary sinus. The primary target of ablation for PMRF is lateral mitral isthmus. Perimitral reentrant flutter (PMRF) is often encountered during the radiofrequency (RF) ablation of persistent atrial fibrillation (AF) or at the time of follow-up, particularly in the setting of moderate to extensive left atrial substrate ablation. UF Health, Section of Cardiac Electrophysiology, Jacksonville, FLĪBSTRACT. ROBERT KIM, MD, STEVE HSU, MD and JOHN N. Subacute Development of Complete Heart Block After Radiofrequency Ablation of Persistent Atrial Fibrillation ![]()
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