Laurent Pison, MD, Mark La Meir, MD, Harry J. Crijns, MD, PhD

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Left atrial flutter due to incomplete left fibrous trigone linear lesion Laurent Pison, MD, Mark La Meir, MD, Harry J. Crijns, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 142, Issue 5, Pages e149-e151 (November 2011) DOI: 10.1016/j.jtcvs.2011.07.050 Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, 12-Lead electrocardiogram showing atrial flutter with positive flutter waves in lead V1 suggesting left atrial origin. B, His (HBE) and coronary sinus (CS) electrocardiogram showing tachycardia cycle length of 216 ms. C, During endocardial ablation, tachycardia cycle length increased gradually to maximum of 268 ms and then converted to sinus rhythm when the endocardial linear lesion connected to the roofline. The Journal of Thoracic and Cardiovascular Surgery 2011 142, e149-e151DOI: (10.1016/j.jtcvs.2011.07.050) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Voltage map of left atrium Clinical tachycardia was counterclockwise left atrial flutter evolving around mitral annulus (MI) (yellow arrow). By ablating all the remnant endocardial zones of low voltages at the left fibrous trigone line (red dots), we interrupted surviving strands of atrial tissue, creating a linear lesion extending from the MI to the medial aspect of the roofline (white arrow), resulting in a gradual increase of the tachycardia cycle length and, finally, conversion to sinus rhythm. LSPV, left superior pulmonary vein; RSPV, right superior pulmonary vein. The Journal of Thoracic and Cardiovascular Surgery 2011 142, e149-e151DOI: (10.1016/j.jtcvs.2011.07.050) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions