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Vol 16, No 6 (2021)
Case report
Published online: 2021-12-13

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The change of the coronary sinus activation sequence during radiofrequency ablation of cavotricuspid isthmus

Maria Królikowska1, Krzysztof Myrda2, Aleksandra Błachut2, Bartosz Stryczek1, Mariusz Gąsior23
Folia Cardiologica 2021;16(6):412-415.


Typical atrial flutter (AFL) is one of the most common heart rhythm disorders appearing in clinical practice. According to the current guidelines, the recommended treatment method is percutaneous ablation. This procedure aims to obtain a permanent bidirectional conduction block in the cavotricuspid isthmus (CTI).

This report presents a patient with ongoing typical AFL referred to the radiofrequency (RF) ablation. During the RF applications on CTI, the change of coronary sinus activation sequence and prolongation of tachycardia cycle length was observed. Its occurrence is a rare phenomenon and may suggest a change in the course of the macro-re-entry arrhythmia loop.

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