No abstract

Atypical atrial flutter is a rare supraventricular tachyarrhythmia which is extremely challenging to visualize using well-known mapping systems. A new approach using ultra-fast, high-resolution 3D mapping systems could be a step forward in understanding and treatment of this arrhythmia. We report a case of a 54-year-old man with paroxysmal, atypical atrial flutter who was admitted to a tertiary cardiology center. The patient had undergone pulmonary vein isolation due to atrial fibrillation and as a result of the intervention he developed atypical atrial flutter. The arrhythmia had previously been treated with electrical cardioversion but without any success. An ultra-fast, high-density 3D mapping system (Rhythmia, Boston Scientific) was used to determine the arrhythmia localization. Ablation was done with a 8.5F basket mapping catheter equipped with 64 low-noise electrodes. This system allowed for precise and adequate mapping, thus enabling the patient's arrhythmia to convert to sinus rhythm.

In case of the need of pacemaker implantation, patients with artificial tricuspid valve are a special group of subjects, because of high risk of dysfunction of the prosthesis. In case of mechanical prosthesis of tricuspid valve the leads of pacemaker are usually located in coronary sinus. In case of biological prosthesis of tricuspid valve despite of the risk of prosthesis damage the electrodes are implanted endocardially. The leadless pacemakers seems to be promising alternative in patients with artificial tricuspid valve because of minor risk of valve damage. The case report concerns to the patient with tachycardia-bradycardia syndrome and biological prosthesis of tricuspid valve in whom the leadless pacemaker Micra was implanted.