1. Introduction:
The definition of Atypical Atrial Flutter (AAFL) includes a broad
spectrum of macro-reentrant atrial tachycardias (MRAT) in which the
wavefront does not include the Cavo-Tricuspid Isthmus (CTI) part of the
tricuspid annulus [1] .
There is a substantial increase in the incidence of AAFL as an
iatrogenic problem in patients who have had a catheter ablation
procedure for treating AF or a surgical MAZE procedure [2] .
In AAFL, especially in patients who had surgery or catheter ablation, an
electrophysiology study (EP study) is the only way to unveil the
mechanism [3] . An electrophysiology study, including
entrainment characteristics and high-density mapping consistent with
reentry, must confirm the ultimate diagnosis of AAFL [4] .
Catheter ablation is frequently utilized due to lack of efficacy of
medications or significant symptoms and deteriorating left ventricular
function [4,5] .
Entrainment and point-to-point map acquisition with large tip (8mm)
catheter ablation was common until recently. However, in the last few
years, a more comprehensive understanding of propagation and critical
zones has been possible by high-density electroanatomical mapping
utilizing small-diameter, multipolar catheters. Multipolar maps may have
advantages over traditional point-by-point voltage maps. One such
advantage is higher mapping resolution, which facilitates the detection
of slow conduction zones. Additionally, multipolar maps improve the
accuracy and speed of mapping procedures due to the function of smaller
electrodes. Finally, pace capture can be achieved at the lower output
due to increased electrical density [6,7]. Therefore, we
wanted to explore the outcome of the AAFL ablation, considering the
recent changes in mapping and ablation.