[HIGH-DENSITY MAPPING OF ATYPICAL ATRIAL FLUTTER USING A PENTARAY].

This article describes clinical cases with complex cardiac arrhythmias after previous interventions. The aim of this article is to provide the first experience of using the PentaRay high-density mapping catheter in Kazakhstan (Biosense Webster, California, USA). Two clinical cases with the presence of several types of cardiac arrhythmias in each patient are described. The article describes two clinical cases with multiple atrial arrhythmias after previously performed interventional procedures on the left atrium. Both patients underwent radiofrequency isolation of the pulmonary veins, which was performed to treat atrial fibrillation, but was unsuccessful. An additional radiofrequency ablation in the atria was performed to treat continuously recurrent atrial arrhythmias. Patients were 56 and 70 years old. In the first case, atrial fibrillation and ventricular tachycardia occurred after previous severe myocarditis. In the second case, the primary occurrence of atrial fibrillation is associated with age-related atrial myocardial fibrosis and the presence of concomitant pathology such as arterial hypertension. In both cases, Carto3 navigation system (Biosense Webster, California, USA) and PentaRay high-density mapping catheter were used. A distinctive feature of the PentaRay high-density mapping catheter is the presence of 20 electrodes, which are located on five branches while the ThermoCool SmartTouch standard ablation-mapping catheter has only four mapping electrodes. In this regard, the advantage of the PentaRay high-density mapping catheter is the ability to quickly, accurately, safely create a map of target arrhythmia in any part of the heart. In this article a PentaRay high-density mapping catheter is used to map atrial arrhythmias. Thus, at least three mechanisms of the development of atrial arrhythmias were revealed in each patient, including the presence of fractionated electrograms. The CLOSE protocol was used to perform radiofrequency ablation, which is more effective and avoid complications.