HRCR March 2020 Quiz

Editorial note: The following quiz is related to the article Cavotricuspid isthmus ablation for atrial flutter: anatomic challenges and troubleshooting by Christopoulos and colleagues from the March 2020 issue of Heart Rhythm Case Reports.

Question 1: What is the mechanism of atrial flutter ablation failure in a patient with a prominent small cardiac vein or right coronary artery?

A. Catheter instability
B. Inadequate energy delivery on the epicardial surface of the cavotricuspid isthmus
C. Poor blood flow
D. Impedance rise

Question 2: When attempting cavotricuspid isthmus ablation in a patient with prominent pectinate muscles, what catheter maneuver is most likely to be effective?

A. Epicardial ablation
B. Creating an ablation line more laterally than usual position
C. Creating an ablation line more medially than usual position
D. Creating circular ablation lesions around the pectinate muscles

Question 3: During cavotricuspid isthmus ablation, which of the following actions would be a reasonable first step to address the “heat sink” effect caused by a prominent small cardiac vein?

A. Moving the ablation catheter more laterally and increasing power
B. Obstructing small cardiac vein (SCV) flow with another catheter or angioplasty balloon during ablation
C. Epicardial ablation from right coronary artery (RCA)
D. Epicardial ablation from SCV

Question 4: What is a common complication of epicardial ablation of the cavotricuspid isthmus?

A. Right bundle branch block
B. Injury to the right coronary artery
C. Right phrenic nerve injury
D. Transient ischemic attack