Electrophysiological Insights in a Successful Cavotricuspid Isthmus Ablation of an Atypical Denovo Single-Loop Clockwise Epicardial Biatrial Flutter.

Authors

Usnish Adhikari, Shivanathan Marimuthu, Deep Chandh Raja

Published in

Cardiac electrophysiology clinics. Volume 18. Issue 3. Pages 263-268. Epub Jul 09, 2026.

Abstract

Biatrial macro-reentrant tachycardias are rare in patients without prior atrial intervention and often pose diagnostic and therapeutic challenges. We present a case of de novo single-loop biatrial flutter in a structurally normal heart, in which high-density mapping was critical to understanding the reentrant circuit. Initial attempts at ablation in the left atrium were unsuccessful. Successful entrainment could be demonstrated from both the lateral mitral annulus and cavotricuspid isthmus. Ablation at the cavotricuspid isthmus resulted in termination with durable success. This case highlights the importance of reassessing the mechanism when attempts at ablation fail to modify tachycardia and reinforce CTI as a critical substrate even in complex biatrial activation patterns.

PMID:
42580790
Bibliographic data and abstract were imported from PubMed on 12 Aug 2026.

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