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Figure 1 Surface electrocardiograms (I, aVF, V1, V6) of both cavotricuspid isthmus (CTI)-dependent and scar-related atrial flutters in a single patient. In this patient, the presenting flutter was CTI-dependent moving in a classic clockwise direction with a cycle length of 245 ms (A). Although this flutter was successfully ablated with an isthmus ablation line, a second flutter was induced after ablation (B). Although the cycle length of this flutter is similar, the morphology and axis of the P waves is clearly different. This flutter was mapped and found to be coming from a re-entry circuit involving the incisional scar. Creating an ablation line from the incisional scar to the tricuspid annulus terminated this second flutter.
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