Double loop reentrant atrial tachycardia following ablation for atrioventricular nodal reentrant tachycardia

We report a patient with a history of multiple ablations for recurrent atrioventricular nodal reentrant tachycardia who developed an atrial tachycardia four years after his last procedure. Subsequent electroanatomical mapping demonstrated double loop macro-reentrant atrial tachycardia consistent with a roof dependent flutter and a perimitral flutter. We successfully terminated the tachycardia by targeting isthmuses at sites of prior ablation.