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Figure 4 Atrio-Atrial Anastomosis With Donor Isthmus Right Atrial Flutter and Dissociated Native Atrial Rhythm
(A) Fluoroscopic right anterior oblique view shows the position of the duodecapolar catheter with the distal bipoles (D1 to D3) along the tricuspid valve isthmus and the proximal electrode (D10) along the superior aspect of the interatrial septum. (B) Electroanatomic maps of atrio-atrial anastomosis (gray areas identify native atrial tissue). The flutter wave-front involves the donor atrium only and is propagating in a counterclockwise fashion along the tricuspid annulus. (C) Intracardiac activation sequence in the donor atrium confirms counterclockwise activation. A critical isthmus was located near D5 in the lateral right atrium wall. The native atrium was in a dissociated atrial rhythm (D6 to D9) and did not conduct to the donor atrium. Therefore, ablation of the native atrium was not performed. CS = coronary sinus; D1 to D10 = duodecapolar bipoles 1 to 10; DDC = duodecapolar catheter; LV = left ventricle; RV = right ventricle.
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