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Background <p>Atrial arrhythmias are a frequent and clinically significant complication in left ventricular assist device (LVAD)–supported patients, with the potential to impair right ventricular (RV) function, compromise device hemodynamics, and reduce quality of life. While atrial fibrillation (AF) has received considerable attention in this population, the distinct hemodynamic impact of typical cavotricuspid isthmus (CTI)–dependent atrial flutter and the role of catheter-based rhythm control remain poorly characterized.</p> Case presentation <p>A 60-year-old male with non-ischemic cardiomyopathy who underwent HeartMate 3 LVAD implantation as a bridge to transplantation developed typical CTI-dependent atrial flutter refractory to medical therapy, associated with marked deterioration in RV systolic function (TAPSE: 1.2 → 0.82&#xa0;cm; Sm: 6.9 → 5.3&#xa0;cm/s) and adverse LVAD hemodynamics. Electrical cardioversion had been attempted but failed to maintain sinus rhythm. Electrophysiological study using three-dimensional electroanatomic mapping (CARTO system, Biosense Webster) confirmed counterclockwise CTI-dependent atrial flutter. Radiofrequency (RF) ablation of the cavotricuspid isthmus achieved bidirectional conduction block and restored sinus rhythm. The procedure was performed under uninterrupted therapeutic anticoagulation with warfarin.</p> Results <p>At one-month follow-up, RV systolic function improved substantially (TAPSE: 0.82 → 1.19&#xa0;cm; Sm: 5.3 → 6.5&#xa0;cm/s), with concurrent normalization of LVAD hemodynamic parameters and complete resolution of palpitations and dyspnea.</p> Conclusions <p>Catheter ablation of CTI-dependent atrial flutter in a carefully selected LVAD-supported patient yielded significant improvement in RV function, device hemodynamics, and quality of life (QoL), underscoring the potential role of rhythm control in this population.</p>

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Catheter ablation of typical atrial flutter in a patient with left ventricular assist device support: a case report

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月21日

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  • Azmican Kaya,
  • Murat Karaçam,
  • Tezel Kovancı,
  • Seda Tanyeri Uzel,
  • Abdülkadir Uslu

摘要

Background

Atrial arrhythmias are a frequent and clinically significant complication in left ventricular assist device (LVAD)–supported patients, with the potential to impair right ventricular (RV) function, compromise device hemodynamics, and reduce quality of life. While atrial fibrillation (AF) has received considerable attention in this population, the distinct hemodynamic impact of typical cavotricuspid isthmus (CTI)–dependent atrial flutter and the role of catheter-based rhythm control remain poorly characterized.

Case presentation

A 60-year-old male with non-ischemic cardiomyopathy who underwent HeartMate 3 LVAD implantation as a bridge to transplantation developed typical CTI-dependent atrial flutter refractory to medical therapy, associated with marked deterioration in RV systolic function (TAPSE: 1.2 → 0.82 cm; Sm: 6.9 → 5.3 cm/s) and adverse LVAD hemodynamics. Electrical cardioversion had been attempted but failed to maintain sinus rhythm. Electrophysiological study using three-dimensional electroanatomic mapping (CARTO system, Biosense Webster) confirmed counterclockwise CTI-dependent atrial flutter. Radiofrequency (RF) ablation of the cavotricuspid isthmus achieved bidirectional conduction block and restored sinus rhythm. The procedure was performed under uninterrupted therapeutic anticoagulation with warfarin.

Results

At one-month follow-up, RV systolic function improved substantially (TAPSE: 0.82 → 1.19 cm; Sm: 5.3 → 6.5 cm/s), with concurrent normalization of LVAD hemodynamic parameters and complete resolution of palpitations and dyspnea.

Conclusions

Catheter ablation of CTI-dependent atrial flutter in a carefully selected LVAD-supported patient yielded significant improvement in RV function, device hemodynamics, and quality of life (QoL), underscoring the potential role of rhythm control in this population.