![]() A double-lumen endotracheal tube was used to deflate the right lung. The surgical ablation procedure was performed under general anesthesia with endotracheal intubation. ![]() Insurance burns were placed around the nearby area.Ī decision then was made to attempt surgical ablation to interrupt isthmus conduction. An ablation lesion delivered to this site successfully terminated the tachycardia ( Figure 1, bottom). Subsequently, a very tiny ventricular signal (without detectable atrial signal) could be recorded at a location more medial toward the septum and more distal toward the tricuspid annulus (TA) and the right ventricle in the isthmus. Radiofrequency ablation of the CTI at 7:30 o'clock position followed by ablations at 6:30, 5:30, and 5:00 o'clock position in the 50° left anterior oblique projection produced no effects on tachycardia. ![]() Only at a more lateral location in the CTI were there detectable residual atrial signals, whereas there were no or minimal atrial signals at other sites along the whole CTI, presumably owing to the previous ablations. The CTI was mapped carefully and systematically to search for any detectable atrial signals. Entrainment and a 3-dimensional activation map indicated that the tachycardia was consistent with typical counterclockwise CTI-dependent AFL. An open-irrigation deflectable catheter with a 3.5-mm tip (ThermoCool Biosense Webster, Inc, Diamond Bar, Calif) was used for mapping and radiofrequency ablation. The patient underwent repeat electrophysiological study.
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