Simultaneous Occurrence of Atrial Fibrillation and Atrial Flutter

Horvath, George; Goldberger, Jeffrey J.; Kadish, Alan H.

doi:10.1111/j.1540-8167.2000.tb00063.x

Cited by 32 publications

(22 citation statements)

References 12 publications

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“…In the case of the LA, there is substantial evidence that, during AF, activation frequencies are much higher than in the RA. 6,7,9,36 Therefore, one might expect that the breakdown frequency in the LA should be higher than that demonstrated for the RA.…”

Section: Atrial Flutter and Fibrillationmentioning

confidence: 91%

Frequency-Dependent Breakdown of Wave Propagation Into Fibrillatory Conduction Across the Pectinate Muscle Network in the Isolated Sheep Right Atrium

Berenfeld

Zaitsev

Mironov

et al. 2002

Circulation Research

179

139

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Abstract-Atrial fibrillation (AF) may result from stationary reentry in the left atrium (LA), with fibrillatory conduction toward the right atrium (RA). We hypothesize that periodic input to the RA at an exceedingly high frequency results in disorganized wave propagation, compatible with fibrillatory conduction. Simultaneous endocardial and epicardial optical mapping (di-4-ANEPPS) was performed in isolated, coronary-perfused sheep RA. Rhythmic pacing of Bachmann's bundle allowed well-controlled and realistic conditions for LA-driven RA. Pacing at increasingly higher frequencies (2.0 to 6.0 Hz) led to increasing delays in activation distal to major branching sites of the crista terminalis and pectinate bundles, culminating in spatially distributed intermittent blockade at or above Ϸ6.5 Hz. At this "breakdown frequency," the direction of RA propagation became completely variable from beat to beat and thus transformed into fibrillatory conduction. Such frequency-dependent changes were independent of action potential duration. Rather, the spatial boundaries between proximal and distal frequencies correlated well with branch sites of the pectinate musculature. Thus, there exists a breakdown frequency in the sheep RA below which activity is periodic throughout the atrium and above which it is fibrillation-like. The data are consistent with the ideas that during AF, high-frequency activation initiated in the LA undergoes fibrillatory conduction toward the RA, and that sink-to-source effect at branch points of the crista terminalis and pectinate muscles is important in determining the complexity of the arrhythmia. , excitation frequency in the left atrium (LA) may be higher than in the right atrium (RA), 1-5 and LA activation patterns may be spatially and temporally periodic. 6 -8 Moreover, a consistent LA-to-RA dominant frequency (DF) gradient correlates with impulse propagation from LA to RA 9,10 across interatrial pathways, such as Bachmann's bundle (BB) and the inferoposterior pathway along the anterior wall of the coronary sinus. 11 Thus, at least in some cases, AF results from activation by relatively stationary high-frequency sources of impulses, which undergo complex spatially distributed intermittent block patterns, imposed by the presence of functional and/or anatomical obstacles in their path.We sought to study rigorously and in detail the response of the RA to incoming high-frequency excitation from the LA. Specifically, we used an isolated, coronary-perfused RA preparation to quantify the frequency-dependent nature of the propagation of wavefronts entering the RA from BB 9 and the basis of fibrillatory conduction. We hypothesize that the bundle-like structure of the normal RA, with its complicated network of pectinate muscles, is a substrate for frequencydependent conduction delay and block. Our preparation provides realistic and well-controlled conditions for testing such a conjecture. By pacing BB at varying frequencies, we demonstrate that 1:1 propagation across the crista terminalis and the grid of pect...

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Section: Atrial Flutter and Fibrillationmentioning

confidence: 91%

Frequency-Dependent Breakdown of Wave Propagation Into Fibrillatory Conduction Across the Pectinate Muscle Network in the Isolated Sheep Right Atrium

Berenfeld

Zaitsev

Mironov

et al. 2002

Circulation Research

179

139

View full text Add to dashboard Cite

show abstract

“…In their absence, "atypical" F waves might represent atypical AFL (6), variants of typical AFL (5), or AF (7). In fact, atypical ECG F waves that are quasi-regular in one lead (often V1) are frequently classified as AFL (8,9), even though AF with regional intra-atrial organization might present this way (10).…”

mentioning

confidence: 99%

Separating Atrial Flutter From Atrial Fibrillation With Apparent Electrocardiographic Organization Using Dominant and Narrow F-Wave Spectra

Hoppe

Kahn

Feld

et al. 2005

Journal of the American College of Cardiology

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“…Current computerized ECG interpretation is valuable, 35, 36 but largely applies the same criteria as visual interpretation 10 . However, “typical” F‐waves may be obscured in patients with left atrial enlargement, 5 age‐related fibrosis, or pulmonary disease, 9 and may appear to be present in atypical AFl 37 and AF 38, 39 . The visual ECG diagnosis of AF relies heavily upon RR interval irregularity, yet this is nonspecific and also present in other atrial tachyarrhythmias 5, 19 .…”

Section: Discussionmentioning

confidence: 99%

Accurate ECG Diagnosis of Atrial Tachyarrhythmias Using Quantitative Analysis: A Prospective Diagnostic and Cost‐Effectiveness Study

Krummen¹,

Patel²,

Nguyen³

et al. 2010

Cardiovasc electrophysiol

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Introduction-Optimal atrial tachyarrhythmia management is facilitated by accurate ECG interpretation, yet typical atrial flutter (AFl) may present without sawtooth F-waves or RR regularity, and atrial fibrillation (AF) may be difficult to separate from atypical AFl or rapid focal atrial tachycardia (AT). We analyzed whether improved diagnostic accuracy using a validated analysis tool significantly impacts costs and patient care.

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Simultaneous Occurrence of Atrial Fibrillation and Atrial Flutter

Cited by 32 publications

References 12 publications

Frequency-Dependent Breakdown of Wave Propagation Into Fibrillatory Conduction Across the Pectinate Muscle Network in the Isolated Sheep Right Atrium

Frequency-Dependent Breakdown of Wave Propagation Into Fibrillatory Conduction Across the Pectinate Muscle Network in the Isolated Sheep Right Atrium

Separating Atrial Flutter From Atrial Fibrillation With Apparent Electrocardiographic Organization Using Dominant and Narrow F-Wave Spectra

Accurate ECG Diagnosis of Atrial Tachyarrhythmias Using Quantitative Analysis: A Prospective Diagnostic and Cost‐Effectiveness Study

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