Radiofrequency catheter ablation for the treatment of human type 1 atrial flutter. Identification of a critical zone in the reentrant circuit by endocardial mapping techniques.

Feld, Gregory K.; Fleck, R. Peter; Chen, Peng‐Sheng; Boyce, Ker; Bahnson, Tristram D.; Stein, Joseph; Calisi, Constance; Ibarra, Miguel

doi:10.1161/01.cir.86.4.1233

Cited by 481 publications

(178 citation statements)

References 8 publications

(5 reference statements)

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“…Initially, high-energy shocks were given endocardially, 17 later followed by local administration of radiofrequency current. 18,19 Nowadays, catheter ablation of AFl has become a safe, curative, and highly successful procedure, particularly when the right atrial isthmus is incorporated in the flutter circuit. Demonstration of bidirectional isthmus block after ablation predicts a high long-term success.…”

Section: Catheter Ablationmentioning

confidence: 99%

Contemporary Management of Atrial Flutter

Wellens

2002

Circulation

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Section: Catheter Ablationmentioning

confidence: 99%

Contemporary Management of Atrial Flutter

Wellens

2002

Circulation

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“…R adiofrequency (RF) ablation is widely used [1][2][3][4][5][6][7] to cure symptomatic patients with common atrial flutter (AF). Some authors even propose that RF ablation could be used as a first line treatment in this clinical setting.…”

mentioning

confidence: 99%

Cavotricuspid Isthmus Mapping to Assess Bidirectional Block During Common Atrial Flutter Radiofrequency Ablation

Chen¹,

Chillou²,

Basiouny³

et al. 1999

Circulation

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Background-We sought to compare published methods to an alternative approach ascertaining cavotricuspid isthmus (CTI) block during atrial flutter ablation. Methods and Results-In 39 consecutive patients who underwent an atrial flutter ablation procedure, a 24-pole mapping catheter was positioned so that 2 adjacent dipoles were bracketing the targeted CTI line of block (LOB), with proximal dipoles lateral to the LOB and distal dipoles in the coronary sinus. Two pacing sites were lateral (positions A and B) and 2 were septal (positions C and D) to the LOB, with locations A and D closest to the LOB. A resulting CTI block was accepted when 3 criteria were fulfilled: (1) complete reversal of the right atrial depolarization on the 24-pole catheter when pacing in the coronary sinus, (2) conduction delays from A to D greater than from B to D, and (3) conduction delays from D to A greater than from C to A. A successful CTI block was obtained in all patients. Before CTI block was obtained, a progressive CTI conduction delay was observed in 11 patients (28.2%). During the procedure, the 3 criteria defined above were either all present or all absent. Conclusions-This study establishes that reversal of the atrial depolarization sequence up to the LOB is a definitive and mandatory criteria of successful atrial flutter ablation. (Circulation. 1999;100:2507-2513.)

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“…[1][2][3][4][5] In a canine experimental model of atrial flutter with an intercaval obstacle, Rosenblueth and Garcia Ramos showed that mechanical injury with a hemostat forceps starting from the orifice of the inferior vena cava or the intercaval obstacle to the tricuspid annulus eventually eliminated atrial flutter, if there was no conducting bridge left between the anatomical obstacle and the tricuspid annulus.6) This finding was supported by other investigators in the same experimental model. 7) This suggests that the tricuspid annulus is not essential for intraatrial reentry to occur in this canine experimental model.…”

mentioning

confidence: 83%

Essential Pathway of Reentry in the Canine Model of Atrial Flutte. Analysis Using Radiofrequency Ablation.

et al. 1997

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SUMMARYIn humans, the isthmus in the low right atrium between the tricuspid annulus and the inferior vena cava or the coronary sinus ostium is a wellestablished target of catheter ablation of common atrial flutter. In the canine model of atrial flutter with a Y-shaped incision, the tricuspid annulus was thought to constitute the essential reentrant pathway. The present study was designed to determine whether the supravalvular tissue around the tricuspid annulus is essential to atrial flutter in the canine model with an intercaval obstacle on the basis of the results of radiofrequency ablation. Epicardial approach of radiofrequency ablation was tested in 4 groups of dogs. Group A (5 dogs): Single application of radiofrequency energy (20W) for 5sec to the mid right atrial free wall. Group B (9 dogs): One to two applications to the tricuspid annulus. A ligature was also placed encircling the tricuspid annulus from the supravalvular atrial tissue to the subvalvular ventricular tissue. Group C (9 dogs): Linear transverse applications to the mid right atrial free wall between the tricuspid annulus and the intercaval obstacle. Group D (10 dogs): The isthmus between the inferior vena cava and the tricuspid annulus was ablated. After the experiment, the heart was excised for anatomical and histological studies. Atrial flutter was never abolished in all dogs in Groups A and B. A ligature encircling the tricuspid annulus also failed to terminate atrial flutter in 2 dogs tested. In contrast, atrial flutter was successfully abolished in 6 dogs (67%) of Group C and in 7 dogs (70%) of Group D. Total energy delivered was significantly higher in Group C than in Group D (364 joules, p<0.003). The total energy required for successful ablation was related to the cross sectional area of the ablation site (r=0.55, p<0.05). These results indicate that the tricuspid annulus is not an essential part of the reentrant pathway in the canine model of atrial flutter with an intercaval obstacle. The

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Radiofrequency catheter ablation for the treatment of human type 1 atrial flutter. Identification of a critical zone in the reentrant circuit by endocardial mapping techniques.

Cited by 481 publications

References 8 publications

Contemporary Management of Atrial Flutter

Contemporary Management of Atrial Flutter

Cavotricuspid Isthmus Mapping to Assess Bidirectional Block During Common Atrial Flutter Radiofrequency Ablation

Essential Pathway of Reentry in the Canine Model of Atrial Flutte. Analysis Using Radiofrequency Ablation.

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