Fei Lü, MD, PhD, FACC, FHRS, Taibo Chen, MD, Kenneth K

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Surgical ablation of typical atrial flutter refractory to catheter ablation Fei Lü, MD, PhD, FACC, FHRS, Taibo Chen, MD, Kenneth K. Liao, MD, PhD, FACS, David G. Benditt, MD, FACC, FRCPC, FHRS The Journal of Thoracic and Cardiovascular Surgery Volume 145, Issue 6, Pages e73-e75 (June 2013) DOI: 10.1016/j.jtcvs.2013.03.002 Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Top panel, Atrial tachycardia (cycle length, 360 ms) on a 12-lead electrocardiogram. The P-wave morphology during tachycardia is consistent with typical atrial flutter. Bottom panel, Catheter ablation of atrial flutter in the cavotricuspid (CTI). The view of the CTI by 3-dimensional mapping using the EnSite NavX system (St. Jude Medical, St Paul, Minn) is shown at bottom left. Ablation at “1” terminated tachycardia but it remained inducible. Ablation at “2” terminated the induced tachycardia, and it remained noninducible thereafter. Note the pouch at location 2 in the isthmus. Tachycardia was terminated successfully (bottom right) after a 9-second ablation at location “2.” Note the absence of atrial electrograms at this successful ablation site. RV, Right ventricular; IVC, inferior vena cava. See the text for more details. The Journal of Thoracic and Cardiovascular Surgery 2013 145, e73-e75DOI: (10.1016/j.jtcvs.2013.03.002) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Surgical dissection of the cavotricuspid isthmus (CTI). Top, A picture was taken during the surgical procedure. The surgical incision was made from the inferior vena cava (IVC) (left end) to the tricuspid annulus (TCA) (right end). Black arrows indicate the incision and blue arrows indicate the thickened right atrial wall. Bottom, The surgical incision was made in the CTI. SVC, Superior vena cava. See the text for more details. The Journal of Thoracic and Cardiovascular Surgery 2013 145, e73-e75DOI: (10.1016/j.jtcvs.2013.03.002) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions