Noncontact electroanatomic mapping to characterize typical atrial flutter: participation of right atrial posterior wall in the reentrant circuit
Abstract
BACKGROUND: Reentry utilizing cavotricuspid isthmus (CTI) is accepted as the mechanism underlying typical atrial flutter (AFLT). However, it is unclear how the right atrial (RA) posterior wall (PW) participates in AFLT circuit. We sought to investigate this by using noncontact electroanatomic mapping. METHODS: Fifteen patients (pts) undergoing ablation for typical AFLT participated. Multipolar catheters were deployed in RA and coronary sinus. RA shell was created during AFLT. Entrainment was performed to confirm CTI dependence and assess participation of various RA regions (septum-Sep, PW, lateral wall-LW). Data were analyzed for (1) RA activation patterns and (2) conduction time (CT) through various RA regions. RESULTS: Mean pt age was 70 ± 13 years (all males; CCW = 10; CW = 5). Mean AFLT cycle length was 255 ± 15 ms. Single activation wave front traversing sequentially CTI, Sep, and LW was seen in all pts and in 12 (80%; 9 CCW, 3 CW) this also traversed PW. Entrainment confirmed PW participation in 7 of these. Mean CT (in ms) through various RA regions was as follows: CTI = 69 ± 27, Sep = 50 ± 39, PW = 65 ± 35, and LW = 76 ± 35; P = NS. CONCLUSION: These observations offer new insights regarding the participation of PW in the reentrant circuit of typical AFLT in some patients.
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If complete block is present, the superior turning point is the atrial roof between SVC and tricuspid ring; otherwise it may be at different levels of the postero-lateral wall across the crista terminalis.
“If complete block is present, the superior turning point is the atrial roof, between the superior vena cava (SVC) and the tricuspid ring, but in other cases the turning point may be at different levels of the postero-lateral wall, across the crista terminalis.125 -127”
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- Authors
- DIXIT, S., LAVI, N., ROBINSON, M., RILEY, M. P., CALLANS, D. J., MARCHLINSKI, F. E., & LIN, D.
- Affiliations
- Hospital of the University of Pennsylvania (US)
- Corresponding author
- DIXIT, SANJAY
- ORCID
- Venue
- Journal of Cardiovascular Electrophysiology
- Publisher
- Wiley
- Published
- 2010-10-11
- Volume
- 22
- Issue
- 4
- Pages
- 422-430
- ISSN
- 1045-3873 (ISSN-L)
- 1540-8167
- OpenAlex
- W1990875509
- Cited by
- 14
- References
- 22
- Citations by year
- 2024: 1 · 2019: 1 · 2018: 1 · 2017: 3 · 2016: 1 · 2014: 1 · 2012: 5
- FWCI
- 1.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Cardiovascular 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
- typical atrial flutter, reentrant circuit, cavotricuspid isthmus, atrial activation patterns, conduction time, entrainment, atrial flutter ablation
- MeSH terms
- Aged, Aged, 80 and over, Atrial Flutter, Electrocardiography, Heart Atria, Heart Conduction System, Humans, Male, Middle Aged, Body Surface Potential Mapping
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