Anatomic and electrophysiologic differences between chronic and paroxysmal atrial flutter: intracardiac echocardiographic analysis
Abstract
BACKGROUND: It remains unknown why atrial flutter (AFL) occurs as either a chronic or paroxysmal arrhythmia. PURPOSE: The aim of the study was to compare intracardiac echocardiographic (ICE) images of the crista terminalis (CT) and transverse conduction properties of the CT between chronic and paroxysmal forms of common AFL. METHODS: Chronic AFL (n = 7) was defined as non-self-terminating AFL lasting >1 month, and paroxysmal AFL (n = 8) was defined as an intermittent arrhythmia with symptomatic episodes of 24 hours maximum duration. ICE images of the right atrium were recorded with a 9 F 9-MHz intracardiac ultrasound catheter during pullback at 0.5-mm intervals from the superior vena cava to the inferior vena cava triggered by electrocardiogram and respiration. The two-dimensional image of the right atrium was reconstructed into a three-dimensional (3-D) image. RESULTS: Three-dimensional images from patients with chronic AFL showed the CT to be thick and continuous, and conduction across the CT was blocked at a pacing rate just above sinus rhythm in all seven patients. In contrast, 3D images from paroxysmal AFL showed the CT to be thin and discontinuous, and conduction across the CT during midseptal pacing was observed in five of the eight patients. CONCLUSION: The nature of AFL is determined, at least in part, by anatomic and electrophysiologic characteristics of the CT.
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The diameter of the circuit necessary to sustain reentry depends on the area or line of block in the posterior RA, consistent with increased thickness and increased capacity to block transverse conduction at the crista terminalis.
“The diameter of the circuit, necessary to sustain reentry is dependent on the presence of the area or line of block in the posterior RA, which is in keeping with an increased thickness, 128,129 and the increased capacity to block transverse conduction at the crista terminalis.123,130”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [128]
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- Authors
- OHKUBO, K., WATANABE, I., OKUMURA, Y., ASHINO, S., KOFUNE, M., KAWAUCHI, K., YAMADA, T., KOFUNE, T., HASHIMOTO, K., SHINDO, A., SUGIMURA, H., NAKAI, T., KUNIMOTO, S., SAITO, S., & HIRAYAMA, A.
- Affiliations
- Nihon University (JP)
- Corresponding author
- WATANABE, ICHIRO
- Venue
- Pacing and Clinical Electrophysiology
- Publisher
- Wiley
- Published
- 2008-03-27
- Volume
- 31
- Issue
- 4
- Pages
- 432-437
- ISSN
- 0147-8389 (ISSN-L)
- 1540-8159
- OpenAlex
- W2055885887
- Cited by
- 13
- References
- 21
- Citations by year
- 2022: 1 · 2021: 2 · 2018: 1 · 2016: 1 · 2015: 1 · 2012: 4
- FWCI
- 0.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pacing and Clinical Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Keywords
- atrial flutter, paroxysmal atrial flutter, crista terminalis, conduction block, right atrium, intracardiac echocardiography, 3D reconstruction, interatrial septum, arrhythmia mechanisms
- MeSH terms
- Acute Disease, Adult, Aged, Atrial Flutter, Chronic Disease, Female, Humans, Male, Middle Aged, Ultrasonography, Interventional, Body Surface Potential Mapping, Echocardiography, Three-Dimensional
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