A very narrow preexisting isthmus in a case with typical atrial flutter

A 61-year-old woman with typical atrial flutter underwent an electrophysiologic study and radiofrequency catheter ablation. The electroanatomic mapping revealed two contiguous lines of distinct double potentials (DPs) extending anteriorly/posteriorly from the coronary sinus ostium to the inferior vena cava (IVC) border. A large part of the anterior line of the DPs was close and parallel to the tricuspid annulus (TA). An initial discrete radiofrequency application at the very narrow preexisting isthmus between the TA and anterior line of the DPs completed the IVC-TA isthmus conduction block.