Rate-Dependent Conduction Block of the Crista Terminalis in Patients With Typical Atrial Flutter

Arenal, Ángel; Almendral, Jesús; Alday, Jesús Ma; Pérez-Villacastín, Julián; Ormaetxe, José; Sande, José Luis Martínez; Pérez‐Castellano, Nicasio; González, Sergio; Ortiz, Mercedes; Delcán, Juan L.

doi:10.1161/01.cir.99.21.2771

Cited by 109 publications

(87 citation statements)

References 22 publications

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“…18,19 Localization of the block line, the posterior barrier of the AFL circuit, has been reported to exclude the CT. A functional block has been seen in the sinus venosa area during CCW and CW AFL. 20 We demonstrated 3 types of conduction block in the posterolateral RA.…”

Section: Conduction Patterns In Characteristic Posterolateral Block Dmentioning

confidence: 99%

Activation Patterns and Conduction Velocity in Posterolateral Right Atrium During Typical Atrial Flutter Using an Electroanatomic Mapping System

Sawa

Shimizu

Ueyama

et al. 2008

Circ J

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Background To investigate the activation patterns and conduction velocity (CV) in the posterolateral right atrial (RA) wall during typical counterclockwise atrial flutter (AFL) using an electroanatomic mapping system. Methods and Results During typical AFL in 25 patients, the transverse conduction pattern and CV were classified and calculated. The line blocking transverse conduction was defined by the conduction pattern and double potentials recorded during mapping. There were 3 types (including 2 subtypes) of transverse conduction pattern based on the conduction blocks across the posterolateral RA in a line between the superior and inferior venae cava. Trans-cristal conduction activation in a horizontal direction was seen in all but 4 patients. The CV in the gap area was 0.59±0.21 m/s. Conclusions Three types of transverse conduction pattern were observed during trans-ctristal conduction and the trans-ctristal CV was relatively slower than that in other parts of the RA, except for the isthmus. (Circ J 2008; 72: 384 -391)

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Section: Conduction Patterns In Characteristic Posterolateral Block Dmentioning

confidence: 99%

Activation Patterns and Conduction Velocity in Posterolateral Right Atrium During Typical Atrial Flutter Using an Electroanatomic Mapping System

Sawa

Shimizu

Ueyama

et al. 2008

Circ J

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“…Changes in the intraatrial activation pattern around the tricuspid annulus during pacing from the successful ablation site with different cycle lengths are shown in Fig 6. Pacing with a relatively longer cycle length of 400 ms resulted in clockwise activation around the tricuspid annulus (Fig 6, Left panel). However, pacing with a shorter cycle length of 210 ms, which was the However, during pacing with a shorter cycle length of 210 ms (Right panel), the same as the tachycardia cycle length, exhibited a counterclockwise activation around the tricuspid annulus, which might indicate functional block in the posterior portion of the right atrium (sinus venosa region 11,12 or crista terminalis 13 ). Abbreviations as in Figs 2,4. same as the AT cycle length, resulted in a counterclockwise activation around the annulus (Fig 6, Right panel).…”

Section: -Fr Octapolar Catheter (Cs 8) Was Positioned (Figs 5bc)mentioning

confidence: 93%

Atrial Tachycardia Arising From the Right Atrial Inferoseptum Masquerading as Common Atrial Flutter

Ito

Tada

Nogami

et al. 2007

Circ J

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ost focal atrial tachycardias (ATs) originate from the right atrium (RA), the orifice of the pulmonary veins or the mitral annulus in the left atrium, 1-8 and radiofrequency (RF) catheter ablation has become an effective curative therapy. [1][2][3][4][5][6][7][8][9] In the RA, AT often originates along the crista terminalis, para-Hisian region, or from the inferoseptum, including the ostium of the coronary sinus (CS). [1][2][3][4][5][6][7] We describe 2 cases of AT arising from the RA inferoseptum. The remarkable characteristics of the tachycardia were that it masqueraded as isthmus-dependent, common atrial flutter (AFL). Case Reports Patient 1A 34-year-old woman with a 1-year history of incessant, exercise-induced palpitation attacks was admitted for evaluation of the tachycardia. A "saw-tooth" pattern in the inferior leads, and negative P-wave polarity in lead V6 and positive in lead V1 during the tachycardia with a cycle length of 210 ms mimicked common AFL (Fig 1A). After informed consent was obtained, catheter ablation was performed. At the beginning of the procedure, the patient had a normal sinus rhythm. The activation sequence across the cavo-tricuspid isthmus was in a clockwise direction during pacing from the CS ostium with a cycle length of 600 ms. The tachycardia could not be induced by programmed atrial stimuli. However, it could be induced by isoproterenol infusion, with a warm-up and cool-down phenomena, suggesting that the mechanism of this AT was automaticity. Activation mapping demonstrated a counterclockwise activation sequence around the tricuspid annulus during the tachycardia ( Fig 1B). The earliest atrial activation was found at a site near the CS ostium. The ablation catheter became stabilized at that site after clockwise torquing the catheter against the RA inferoseptum, away from the CS ostium. The local electrograms at that site exhibited double potentials, and a small, first potential preceded the atrial potential recorded at the CS ostium by 41 ms (Fig 2A). The tachycardia was eliminated by a single application of RF energy at that site. In the right anterior oblique view, the successful ablation site was posterior to the superior rim of the CS ostium, and corresponded to the Eustachian ridge (ER) (Fig 2B). The P-wave morphology and polarity during pacing from the successful ablation site were almost identical to those of the clinical tachycardia. During the tachycardia, a counterclockwise activation sequence was observed around the tricuspid annulus. However, during pacing from the ablation site with a longer cycle length of 600 ms after the ablation, the activation sequence across the isthmus was in the clockwise direction (Fig 2C). The patient was discharged without the need for medications and has done well with no AT recurrence during a 2-year follow-up period. Patient 2A 75-year-old man presented with a 2-year history of recurrent episodes of palpitation attacks. From the electrocardiographic findings recorded during the palpitations, he was diagnosed with common AFL. An intrav...

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“…However, majority of the cases include structural and electrical abnormalities (similar to AFIB) as the main culprit behind the flutter waves [33–35]. One major difference in AFIB and AFLUT is that the thickness of the terminal crest of the atria and its capacity to block transverse conduction are increased in cases of AFLUT compared to AFIB [36,37]. Some literature also suggests left atrial dilatation as one of the strongest predictors of developing AFLUT in the recent future [38].…”

Section: Pathophysiologymentioning

confidence: 99%

Management of atrial fibrillation-flutter: uptodate guideline paper on the current evidence

Shah

Luu

Calestino

et al. 2018

Journal of Community Hospital Internal Medicine Perspectives

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The term ‘flutter’ and ‘fibrillation’ were first coined to differentiate the differences between fast, regular contractions in Atrial Flutter (AFLUT) with irregular, vermiform contractions of Atrial Fibrillation (AFIB). Management of these two diseases has been a challenge for physicians. Rate control (along with rhythm control) is the first line of management for symptomatic AFIB/AFLUT with Rapid Ventricular Rate (RVR). In some situations, atrial rhythms may not be well controlled by these anti-arrhythmic drugs, making cardioversion to sinus rhythm necessary. Anti-coagulation therapy in both the disease population is essential. Catheter ablation is an effective treatment option in certain patients that have AFIB/AFLUT refractory to medical management. Newer techniques like left atrial appendage (LAA) has been developed and is a highly attractive concept for the future in the management of AFIB/AFLUT. Newer novel drugs targeting specific ion channels are approaching the stages of clinical investigation. However, while advances in technologies have helped elucidate many aspects of these diseases, many mysteries still remain. This literature review serves as one of the guideline papers for current up-to-date management on both AFIB and AFLUT.

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Rate-Dependent Conduction Block of the Crista Terminalis in Patients With Typical Atrial Flutter

Cited by 109 publications

References 22 publications

Activation Patterns and Conduction Velocity in Posterolateral Right Atrium During Typical Atrial Flutter Using an Electroanatomic Mapping System

Activation Patterns and Conduction Velocity in Posterolateral Right Atrium During Typical Atrial Flutter Using an Electroanatomic Mapping System

Atrial Tachycardia Arising From the Right Atrial Inferoseptum Masquerading as Common Atrial Flutter

Management of atrial fibrillation-flutter: uptodate guideline paper on the current evidence

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