![]() ![]() Therefore, we started with CTI linear ablation instead of focal ablation because macro-reentry CTI dependent atrial flutter was more prevalent, and focal ablation in mid-septum took more risk in AV node injury. Without entrainment, we cannot confirm the mechanism. In the first step, isochronal map showed two reentry circuits, one with macro-reentry counterclockwise atrial flutter and the other with localized reentry confined at mid-septum. In frame ( B), ablation lesion set showed initial cavo-tricuspid isthmus (CTI) linear ablation failed to terminate the atrial flutter instead, focal ablation at the highlighted area by Skyline valley successfully terminated atrial flutter to sinus rhythm (SR). ![]() In frame ( A), 1 denotes first step to determine the possible main circuit in isochronal map 2 denotes second step to scan the Skyline, identify the GAH-valley, and check the corresponding highlighted area in isochronal map and 3 denotes third step to confirm the wave-front property and characteristics of local signals in highlighted area. Illustration of stepwise approach in application of LUMIPOINT & Skyline for aAFL in a patient with prior cardiac surgery. Lumipoint algorithm atypical atrial flutter catheter ablation global activation histogram high-density mapping system. The results were the efficient detection of the slow conduction, better identification of ablation sites, and fast termination of the aAFL with favorable outcomes. Conclusions: The present study showed benefits of the LumipointTM module applied to the RhythmiaTM mapping system. These sites corresponded with the areas highlighted by GAH-score < 0.4 in reentry aAFL, and by GAH-score < 0.2 in localized-reentry aAFL. Successful sites of ablation all matched one of the highlighted areas based on GAH-valleys < 0.4. Each GAH-valley highlighted 1.9 areas in the map. Most reentry aAFL (18/20, 90%) lacked a plateau and displayed a steep GAH-valley with 2 GAH-valleys per tachycardia. Results: Reentry aAFL in SKYLINE typically was a multi-deflected peak with 1.5 GAH-valleys. Methods: Fifteen patients presenting with 20 different incessant aAFL, including two naïve, six with a prior AF ablation, and seven with prior cardiac surgery were studied. Aims: To revisit aAFL, we used a novel Lumipoint algorithm in the Rhythmia mapping system to evaluate tachycardia circuit by the patterns of global activation histogram (GAH, SKYLINE) in assisting aAFL ablation. Background: Atypical atrial flutter (aAFL) is not uncommon, especially after a prior cardiac surgery or extensive ablation in atrial fibrillation (AF). ![]()
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