Conduction Properties of the Inferior Vena Cava‐Tricuspid Annular Isthmus in Patients with Typical Atrial Flutter

Kinder, Charles; Kall, John G.; Kopp, Douglas E.; Rubenstein, Donald S.; Burke, Martin C.; Wilber, David J.

doi:10.1111/j.1540-8167.1997.tb00831.x

Cited by 36 publications

(24 citation statements)

References 20 publications

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“…[15][16][17] The surface ECG generally demonstrated negative flutter waves in leads II, III, and aVF, and isoelectric or positive flutter waves in lead V 1 . Clockwise type I atrial flutter was considered present if clockwise activation around the tricuspid annulus was demonstrated and concealed entrainment could be demonstrated from annular pacing sites within the tricuspid valve-eustachian ridge isthmus, with a postpacing interval similar to the flutter cycle length.…”

Section: Definitionsmentioning

confidence: 99%

“…A deflectable quadripolar catheter (Cordis Webster, 2-5-2 mm spacing) was positioned at the inferolateral tricuspid annulus for pacing and recording from the lateral isthmus. 15 Annular activation during atrial flutter or atrial pacing was assessed by either a second roving deflectable quadripolar catheter, or a 20-electrode Halo catheter (Cordis Webster, 2-7-2 mm intervals). Patients were studied in the fasting state and sedated with intravenous midazolam and fentanyl.…”

Section: Electrophysiological Studymentioning

confidence: 99%

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Atrial Fibrillation After Radiofrequency Ablation of Type I Atrial Flutter

et al. 1998

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Background-The occurrence of atrial fibrillation after ablation of type I atrial flutter remains an important clinical problem. To gain further insight into the pathogenesis and significance of postablation atrial fibrillation, we examined the time to onset, determinants, and clinical course of atrial fibrillation after ablation of type I flutter in a large patient cohort. Methods and Results-Of 110 consecutive patients with ablation of type I atrial flutter, atrial fibrillation was documented in 28 (25%) during a mean follow-up of 20.1Ϯ9.2 months (cumulative probability of 12% at 1 month, 23% at 1 year, and 30% at 2 years). Among 17 clinical and procedural variables, only a history of spontaneous atrial fibrillation (relative risk 3.9, 95% confidence intervals 1.8 to 8.8, Pϭ0.001) and left ventricular ejection fraction Ͻ50% (relative risk 3.8, 95% confidence intervals 1.7 to 8.5, Pϭ0.001) were significant and independent predictors of subsequent atrial fibrillation. The presence of both these characteristics identified a high-risk group with a 74% occurrence of atrial fibrillation. Patients with only 1 of these characteristics were at intermediate risk (20%), and those with neither characteristic were at lowest risk (10%). The determinants and clinical course of atrial fibrillation did not differ between an early (Յ1 month) compared with a later onset. Atrial fibrillation was persistent and recurrent, requiring long-term therapy in 18 patients, including 12 of 19 (63%) with prior atrial fibrillation and left ventricular dysfunction. Conclusions-Atrial fibrillation after type I flutter ablation is primarily determined by the presence of a preexisting structural and electrophysiological substrate. These data should be considered in planning postablation management. The persistent risk of atrial fibrillation in this population also suggests a potentially important role for atrial fibrillation as a trigger rather than a consequence of type I atrial flutter. (Circulation. 1998;98:315-322.)

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Section: Definitionsmentioning

confidence: 99%

Section: Electrophysiological Studymentioning

confidence: 99%

Atrial Fibrillation After Radiofrequency Ablation of Type I Atrial Flutter

et al. 1998

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“…An area of slow conduction has been shown to be present in the CTI, accounting for one-third to one-half of the AFL cycle length (CL) [8][9][10]. The CTI is anatomically bounded by the inferior vena cava and Eustachian ridge posteriorly and the tricuspid valve annulus anteriorly ( Figure 20.1a & b), both of which form lines of conduction block or barriers delineating a protected zone in the reentry circuit [5,[11][12][13].…”

Section: Pathophysiological Mechanisms Of Typical (And Reverse Typicamentioning

confidence: 99%

Mapping of Human Atrial Flutter and Its Variants

2012

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Mapping of human typical atrial flutter (AFL) and its variants can be performed with standard catheter techniques, with special attention to activation patterns and responses to entrainment, allowing one to make an accurate diagnosis that will result in successful ablation of the underlying substrate. Computerized three-dimensional activation mapping is an adjunctive procedure, which while not mandatory may provide significant advantages in some cases, resulting in improved cure rates. The most common forms of AFL in humans include typical (counterclockwise) and reverse typical (clockwise) AFL. The less common variants include upper and lower loop reentrant AFL, partial isthmus dependent AFL, and scar related reentrant AFL. Other forms of AFL, which are rarely seen in humans spontaneously, including intra-isthmus reentry, and atypical left atrial flutter, are more likely to occur after prior ablation procedures. Radio-frequency catheter ablation has become a first line treatment for typical (and reverse typical) AFL, with nearly uniform acute and chronic success and low complication rates. Large-tip or irrigated ablation catheters are recommended for optimal success. Alternate energy sources are under investigation for ablation of AFL, including cryoablation and microwave ablation, with a goal improving procedure times and success rates, and reducing risk of complications.

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“…Comparison of CW and CCW AFL Tai et al (12) and Feld et al (11) demonstrated rate-dependent slowing of the trans-isthmus conduction, whereas Kinder et al (17) and Lin et al (7) did not show such a phenomenon using a similar pacing protocol. We think that these differences may depend on using different kinds of catheters (they may cause different positioning of the electrodes) and different calculating methods.…”

Section: Figure 1 Measurement Of the Conduction Velocity (Cv) In Isomentioning

confidence: 99%

“…We think that these differences may depend on using different kinds of catheters (they may cause different positioning of the electrodes) and different calculating methods. CCW and CW CVs of CTI seem to be also different in AFL patients compared with the control (11,17,18). Morita et al (19) has found that the CW conduction in the low RA isthmus was significantly slower than the CCW direction.…”

Section: Figure 1 Measurement Of the Conduction Velocity (Cv) In Isomentioning

confidence: 99%

Novel method to evaluate the conduction velocity and conducting area during isthmus-dependent atrial flutter

Erdem

Gölcük²,

Küçükdurmaz³

et al. 2011

Anadolu Kardiyol Derg

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Objective: The difference of the conduction velocity (CV) around the tricuspid valve annulus between the counter-clockwise (CCW) atrial flutter and the clockwise (CW) atrial flutter has not been well clarified. This study was undertaken to evaluate the CV and the conducting area (CA) per millisecond around the tricuspid valve annulus using the electroanatomical mapping. Methods: The electroanatomical mapping was performed during the tachycardia for 30 consecutive patients (mean age: 61±16 years) with isthmusdependent atrial flutter (CCW, 25; CW, 5). We measured the CV and the CA of five divided areas of the right atrium, that is, upper septum (US), lower septum (LS), isthmus (I), upper lateral wall (UL) and lower lateral wall (LL) using the novel measurement method in the isochronal map. Statistical differences of these data between the two groups were assessed by the Student's t-test and one-way analysis of variance methods. Results: In total, the CV of the LS was significantly slower than other areas (m/sec: US, 0.57±0.18; LS, 0.43±0.18; UL, 0.60±0.26; LL, 0.53±0.20; I, 0.50±0.17; p<0.05) and the CA of the US and UL were significantly larger than other areas (mm 2 /sec: US, 34.5±16.2; LS, 16.2±9.5; UL, 40.0±14.1; LL, 27.0±17.0; I, 16.8±8.5; p<0.0001). There was no significant difference between the CCW and the CW atrial flutters in terms of the CV and the CA of equally divided five areas. Conclusion: In both of the CCW and the CW atrial flutters, the CV of the LS was significantly slower than other areas and the CA of the lower atrium was significantly smaller than the upper atrium. (Anadolu Kardiyol Derg 2011; 11: 711-6)

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Conduction Properties of the Inferior Vena Cava‐Tricuspid Annular Isthmus in Patients with Typical Atrial Flutter

Abstract: Decremental conduction is not characteristic of activation through the isthmus when activation is assessed parallel and adjacent to the tricuspid annulus. Functional slowing or conduction delay does not develop in this region during typical atrial flutter.

Cited by 36 publications

References 20 publications

Atrial Fibrillation After Radiofrequency Ablation of Type I Atrial Flutter

Atrial Fibrillation After Radiofrequency Ablation of Type I Atrial Flutter

Mapping of Human Atrial Flutter and Its Variants

Novel method to evaluate the conduction velocity and conducting area during isthmus-dependent atrial flutter

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