A clinical case of catheter ablation of typical atrial flutter in a patient after orthotopic heart transplantation

Orthotopic heart transplantation is a significant achievement of modern cardiosurgery for patients with terminal stage of chronic heart failure, where other treatment methods become ineffective. One of the common complications after orthotopic heart transplantation is atrial arrhythmias, which can significantly complicate the recovery process after surgery. Macro-reentry arrhythmias are one of the most common forms of atrial arrhythmias in this patient group. They are caused by significant changes in the geometry of the atria, which occur as a result of the surgical intervention. Typical isthmus-dependent atrial flutter is more common in the donor organ, but atypical forms with extension along the sutures or in the residual tissue of the recipient’s atria are also observed. In this article, we presented a unique clinical case that illustrates the simultaneous presence of typical isthmus-dependent atrial flutter in the donor heart and atypical atrial flutter in the residual tissue of the recipient’s right atrium. We also discussed the methods of electrophysiological diagnosis of these arrhythmias and the successful treatment using catheter ablation.

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