Toddler Cavotricuspid Valve Isthmus Ablation for Typical Atrial Flutter with Cryoablation

Case presentation: We describe the youngest successful cavotricupsid isthmus cryoablation in a 16-month-old toddler with small atrial septal defect whose medical management was complicated by intrinsic atrioventricular nodal conduction disease and recurrent atrial flutter. Methods: Zero fluoroscopy electrophysiology study performed. Cavotricuspid isthmus proved to be “in” circuit with entrainment. Line of block was achieved with termination of atrial flutter using 2 minutes cryolesions. Results: The patient underwent successful cryoablation at 9 kg, without recurrence. Conclusion: Cavotricuspid isthmus ablation using cryoablation resulted in no recurrence of atrial flutter for at least 1 year of follow up. Ablation offers a less invasive alternative to pacemaker implantation in toddlers with coexisting conduction disease, limiting medical management options.