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Safety and feasibility of left atrial flutter ablation with a grid-style high-density mapping catheter in patients with mechanical mitral valve
Session:
Sessão de Posters 54 - Da energia aos endpoints na FA
Speaker:
Daniel Matos
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
06. Supraventricular Tachycardia (non-AF)
Subtheme:
06.4 Supraventricular Tachycardia (non-AF) - Treatment
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Daniel Jorge Nascimento Matos; Pedro Carmo; Daniel Gomes; Guilherme Flor; João Carmo; Gustavo Rodrigues; Francisco Costa; Pedro Galvão Santos; Francisco Morgado; Diogo Cavaco; Pedro Adragão
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><em><span style="font-size:12.0pt">Introduction:</span></em></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The treatment of left atrial arrhythmias in patients with mechanical mitral valve is technically challenging, with increased risk of catheter entrapment, a potential serious procedural complication. We describe a case series of 5 patients with prosthetic mitral valves and left atrial flutter safely mapped and treated with an omnipolar grid-style multielectrode high-density mapping catheter (Advisor™ HD Grid).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><em><span style="font-size:12.0pt">Methods:</span></em></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Retrospective analysis from 2022 to 2025 in a tertiary center of patients with mechanical mitral valve that underwent left atrial flutter ablation with high-density mapping with Advisor™ HD Grid catheter. Procedural characteristics, complications and recorrence were assessed.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><em><span style="font-size:12.0pt">Results:</span></em></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Five patients with a median age of 71 years (range 28–76), four of whom were female, underwent radiofrequency (RF) ablation for symptomatic atypical left atrial flutter. One patient presented with perimitral flutter, two patients had a double-loop flutter dependent on the mitral isthmus and either the roof or the left pulmonary veins, one patient presented a posterior wall–dependent flutter and the last one a right pulmonary veins–dependent flutter. The mapping system used was the EnSite X in four patients and EnSite Precision in one; two of the five procedures employed the more recent Advisor™ HD Grid X version; the TactiFlex™ RF ablation catheter was used in four patients, while the remaining patient was treated with the TactiCath™ RF catheter. The median procedural time was 95 minutes (range 62–180), with a median fluoroscopy time of 7 minutes (range 5–18). The median flutter cycle length was 320 milliseconds (300–340 ms). The median left atrial volume was 159 mL (127–189 mL), and two patients presented moderate or severe left ventricular dysfunction. All flutters were successfully ablated, with restoration of sinus rhythm during RF applications. There was no procedural complications, and all patients were discharged in the following day. At a median follow-up of 270 days (range 70–604), only one patient relapsed and underwent another ablation procedure, this time for a typical atrial flutter. Both patients with left ventricular dysfunction showed improvement of the left ventricular ejection fraction after restoration of sinus rhythm.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><em><span style="font-size:12.0pt">Conclusion:</span></em></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients with left atrial flutter and mechanical mitral valve can be safely and effectively mapped and treated with the omnipolar multielectrode high-density mapping catheter Advisor™ HD Grid.</span></span></p>
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