Rare case of dual-loop biatrial tachycardia involving epicardial
connections between the right-sided pulmonary venous carina and right
Introduction: There are only a few reports of atrial flutter
related to the epicardial connections, referred to as an “intercaval
bundle.” Methods: A 71-year-old man was referred for ablation
of recurrent atrial flutter. Results: Three-dimensional
electroanatomical mapping of the left atrium showed two different
earliest activation sites inside the right pulmonary vein isolation
line. Subsequent mapping of the right atrium showed that the earliest
site was on the posterior side of the superior vena cava. Application of
radiofrequency energy at the carina stopped the tachycardia.
Conclusion: The tachycardia circuit was assumed to be a
dual-loop reentry involving the intercaval bundle.