PMC3924013_01
Resting electrocardiography showed typical atrial flutter with 2:1 or 3:1 conduction before the radiofrequency ablation.
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F1
A 53-yr-old man with persistent atrial flutter (Fig. 1) was admitted on August 20th 2012, to undergo radiofrequency catheter ablation.
Ablation of atrial flutter. (A) The fluoroscopic image, left anterior oblique, showing the position of ablation and diagnostic catheters. (B) Intracardiac electrogram showing typical counterclockwise atrial flutter. ABL, ablation; HIS, His bundle; CS, coronary sinus; RVA, right ventricular apex.
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F2
Jude Medical) (Fig. 2A). Health Care System, Inc., Milwaukee, WI, USA). His baseline intracardiac electrogram showed typical counterclockwise atrial flutter (Fig. 2B). Radiofrequency current was applied to the posteroseptal side of the cavotricuspid isthmus, with temperature limit of 35C and power of 30-35 W (Fig. 2A).
Electrocardiograms. (A) Right after the radiofrequency ablation. Elevation of ST-segment in lead II, III, aVF and reciprocal change in the anterior precordial leads are noted. (B) After an hour of the primary coronary intervention. Previous ST-T changes disappeared.
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F3
We obtained a 12-lead electrocardiogram, which showed ST-segment elevation in leads II, III, aVF, and V5-6 and ST depression in leads I, aVL, and V1-4, suggesting acute myocardial in farction of the inferior wall (Fig. 3).
Acute occlusion of right coronary artery. (A) Coronary angiography, right anterior oblique, showing total occlusion of at the distal portion of right coronary artery (arrow). (B) Revascularization after balloon angioplasty with resultant 20% residual stenosis. (C) The fluoroscopic image, left anterior oblique, showing the position of ablation catheter tip during radiofrequency ablation (arrow).
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F4
Coronary angiography showed total occlusion at the distal portion of the right coronary artery, which was close to the area of ablation (Fig. 4).