Case 15

Abstract

A 75-year-old male with history of orthotopic heart transplantation with a cavo-caval anastomosis initially developed atrial flutter 13 years post-transplantation with an episode of mild rejection. He was successfully treated for rejection and a right atrial cavotricuspid isthmus dependent atrial flutter was ablated. Two years later, presented with palpitations and shortness of breath and was found to have recurrent atrial flutter. Cardiac catheterization and biopsy did not show evidence of transplant coronary artery vasculpathy or acute rejection. What is the most likely mechanism of atrial flutter in this patient? © Springer-Verlag London Limited 2011.