Atypical atrial flutter originating in the right atrial free wall
Abstract
BACKGROUND: Data from experimental models of atrial flutter indicate that macro-reentrant circuits may be confined by anatomic and functional barriers remote from the tricuspid annulus-eustachian ridge atrial isthmus. Data characterizing the various forms of atypical atrial flutter in humans are limited. METHODS AND RESULTS: In 6 of 160 consecutive patients referred for ablation of counterclockwise and/or clockwise typical atrial flutter, an additional atypical atrial flutter was mapped to the right atrial free wall. Five patients had no prior cardiac surgery. Incisional atrial tachycardia was excluded in the remaining patient. High-density electroanatomic maps of the reentrant circuit were obtained in 3 patients. Radiofrequency energy application from a discrete midlateral right atrial central line of conduction block to the inferior vena cava terminated and prevented the reinduction of atypical atrial flutter in each patient. Atrial flutter has not recurred in any patient (follow-up, 18+/-17 months; range, 3 to 40 months). CONCLUSIONS: Atrial flutter can arise in the right atrial free wall. This form of atypical atrial flutter could account for spontaneous or inducible atrial flutter observed in patients referred for ablation and is eliminated with linear ablation directed at the inferolateral right atrium.
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Macroreentrant tachycardia circuits may rotate around the superior vena cava and upper crista terminalis ('upper loop') or around a lateral right atrial surgical scar or a septal patch.
“MRT circuits may turn around the SVC and the upper portions of the crista terminalis ('upper loop') or around a lateral RA surgical scar or a septal patch.159,194”
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 [194]
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References 15 · Cited by 105
Research works printed but not linked: 1
- Boyden PA. Activation sequence during atrial flutter in dogs with sur- gically induced right atrial enlargement. Circ Res. 1988;62:596 -608.
- Authors
- Kall, J. G., Rubenstein, D. S., Kopp, D. E., Burke, M. C., Verdino, R. J., Lin, A. C., Johnson, C. T., Cooke, P. A., Wang, Z. G., Fumo, M., & Wilber, D. J.
- Affiliations
- University of Chicago (US)
- Venue
- Circulation
- Published
- 2000-01-25
- Volume
- 101
- Issue
- 3
- Pages
- 270-279
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2142087625
- Cited by
- 105
- References
- 15
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 1 · 2022: 4 · 2021: 2 · 2020: 2 · 2019: 3 · 2018: 3 · 2017: 1 · 2016: 3 · 2015: 1 · 2014: 2 · 2013: 3 · 2012: 6
- FWCI
- 6.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atypical atrial flutter, right atrial free wall, atrial flutter ablation, radiofrequency catheter ablation, conduction block, electroanatomical mapping, atrial flutter recurrence
- MeSH terms
- Aged, Atrial Flutter, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Middle Aged, Catheter Ablation, Body Surface Potential Mapping
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