Catheter ablation of typical atrial flutter in a patient with left ventricular assist device support: a case report
Abstract
Background: Atrial arrhythmias are a frequent and clinically significant complication in left ventricular assist device (LVAD)-supported patients, with the potential to impair right ventricular (RV) function, compromise device hemodynamics, and reduce quality of life. While atrial fibrillation (AF) has received considerable attention in this population, the distinct hemodynamic impact of typical cavotricuspid isthmus (CTI)-dependent atrial flutter and the role of catheter-based rhythm control remain poorly characterized.
Case presentation: A 60-year-old male with non-ischemic cardiomyopathy who underwent HeartMate 3 LVAD implantation as a bridge to transplantation developed typical CTI-dependent atrial flutter refractory to medical therapy, associated with marked deterioration in RV systolic function (TAPSE: 1.2 → 0.82 cm; Sm: 6.9 → 5.3 cm/s) and adverse LVAD hemodynamics. Electrical cardioversion had been attempted but failed to maintain sinus rhythm. Electrophysiological study using three-dimensional electroanatomic mapping (CARTO system, Biosense Webster) confirmed counterclockwise CTI-dependent atrial flutter. Radiofrequency (RF) ablation of the cavotricuspid isthmus achieved bidirectional conduction block and restored sinus rhythm. The procedure was performed under uninterrupted therapeutic anticoagulation with warfarin.
Results: At one-month follow-up, RV systolic function improved substantially (TAPSE: 0.82 → 1.19 cm; Sm: 5.3 → 6.5 cm/s), with concurrent normalization…
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