Atrial flutter. Electrocardiographic, vectorcardiographic and echocardiographic correlation

Zoneraich, Olga; Zoneraich, Samuel; Rhee, Jai J.; Jordan, D.

doi:10.1016/0002-8703(78)90038-8

Cited by 7 publications

(3 citation statements)

References 15 publications

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“…20 We were unable to confirm that trans-septal conduction in CW-AFL is always via Bachmann's bundle. 8,22 In fact, in our 3 patients with CW-AFL, the site of LA breakthrough was variously located in the superior, in the mid, or in both the mid and the inferior atrial septum. Whether this is related to a block in the input to Bachmann's bundle because of the far-off location of CW-AFL exit (anteroinferior RA) or a block in the specific pathway itself because of the fast flutter rate remains a speculation.…”

Section: Role Of Interatrial Connectionsmentioning

confidence: 83%

“…In patients with CCW-AFL, experimental models, 8,9 vectorcardiography, 22 and CS activation sequence (proximal to distal) 5,7,23 have long since suggested an inferosuperior activation of the major LA mass. In all of our patients with CCW-AFL, the inferior LA was activated in a septal-toposterior direction and the posterior LA in an inferosuperior direction, thus confirming the indirect impression from previous studies.…”

Section: La Activation In Isthmus-dependent Aflmentioning

confidence: 99%

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Biatrial Activation in Isthmus-Dependent Atrial Flutter

et al. 2001

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Background-The aim of this study was to determine the biatrial activation pattern in isthmus-dependent atrial flutter (AFL) to understand the functional interatrial connections and the activation pattern of the left atrium (LA). Methods and Results-Biatrial activation was performed, using an electroanatomic mapping system, in 10 patients undergoing right atrial isthmus ablation for counterclockwise (nϭ7) or clockwise (nϭ3) AFL. The AFL circuit was peritricuspid and propagated slowly (0.5Ϯ0.2 m/s) through the isthmus. LA was activated by two wave fronts, with discrete breakthroughs in the superior, mid, or inferior atrial septum. The activation of LA overlapped 50Ϯ16% of the AFL cycle length. In counterclockwise AFL, at least one breakthrough was located in the inferior atrial septum. LA activation began immediately after the exit of the flutter wave from the isthmus and was directed inferosuperiorly in all patients, being synchronous with the atrial septal activation. The septal breakthroughs in patients with clockwise AFL were variably located. The direction of LA activation was superoinferior in 2 and inferosuperior in 1 patient. Conclusions-The circuit of isthmus-dependent AFL was entirely in the right atrium. LA activation was a bystander and followed trans-septal conduction across the inferior coronary sinus-LA connection, Bachmann's bundle, and/or fossa ovalis. (Circulation. 2001;104:2545-2550.)

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Section: Role Of Interatrial Connectionsmentioning

confidence: 83%

Section: La Activation In Isthmus-dependent Aflmentioning

confidence: 99%

Biatrial Activation in Isthmus-Dependent Atrial Flutter

et al. 2001

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“…In Fig 4, the phase plots of patient 9 corresponding to two episodes of rapid atrial flutter, one spontaneous and the other induced by rapid pacing, are given. The spontaneous episode showed a 4:1 AV conduction, whereas the induced episode was associated with an advanced AV block (range, 4:1 to 8:1).…”

Section: Resultsmentioning

confidence: 99%

Ventricular beats induce variations in cycle length of rapid (type II) atrial flutter in humans. Evidence of leading circle reentry.

et al. 1994

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BACKGROUND Slight variation in cycle lengths of common and rapid atrial flutter in humans is an established phenomenon, but its mechanisms have not been completely clarified. In a previous study, we demonstrated that in common atrial flutter the variations in atrial cycle length were due to atrial stretch affecting the revolution time of a reentrant circuit. In the present study, we investigate the nature of atrial cycle length variations in the rapid type of human atrial flutter. METHODS AND RESULTS Atrial interval variations of 17 episodes of rapid atrial flutter in 14 patients were investigated by measuring the sequence of atrial intervals from intraesophageal or intra-atrial leads and the onset of QRS complexes from a surface lead (V1). To study whether interval variation in flutter cycle was related to ventricular activity, a phase plot was constructed in which the flutter cycle length was plotted against the time after the previous QRS complex. This showed that the interval fluctuations were strictly coupled to the moment of ventricular activation. After the onset of the QRS complex, the rapid atrial flutter interval gradually decreased by an average of 4.1% (P < .001) and reached a minimum value after 300 to 600 milliseconds. Thereafter, the intervals increased again until the next ventricular beat occurred. In 10 patients developing both common and rapid atrial flutter, two different phase relations were found. Whereas during common atrial flutter the atrial interval increased after the QRS complex, it decreased during rapid atrial flutter. In three patients, intra-atrial pressure was recorded together with the electrical activity during both common and rapid atrial flutter episodes. This showed that variations in atrial flutter cycle length were associated with the rise of atrial pressure during ventricular contraction. CONCLUSIONS These findings indicate a role of contraction-excitation feedback caused by atrial stretch after a ventricular activation. The shortening of the atrial interval after the onset of the QRS complex as found in patients during rapid atrial flutter can be explained by stretch-induced shortening of atrial refractoriness and consequent shortening of the revolution time of a functionally determined intra-atrial circuit.

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Clinical vectorcardiography in adults. Part 1

Hoffman

1980

American Heart Journal

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Atrial flutter. Electrocardiographic, vectorcardiographic and echocardiographic correlation

Cited by 7 publications

References 15 publications

Biatrial Activation in Isthmus-Dependent Atrial Flutter

Biatrial Activation in Isthmus-Dependent Atrial Flutter

Ventricular beats induce variations in cycle length of rapid (type II) atrial flutter in humans. Evidence of leading circle reentry.

Clinical vectorcardiography in adults. Part 1

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