Objectives: Using a standardized induction protocol, we investigated the mechanism of initiation of atrial flutter, before ablation, to determine the site of initiating unidirectional block and to test the hypothesis that the direction of rotation of atrial flutter depends on the pacing site from which it initiates.
Background: The high recurrence rate of atrial flutter after presumed successful ablation may be due to difficulty in reinduction after termination. In addition, induction of clockwise flutter is currently of unknown clinical importance.
Methods: Ten patients with documented typical flutter were studied before ablation. A standard protocol consisting of single and double extrastimuli followed by burst pacing was performed from four sites in the right atrium (high and low trabeculated and smooth right atrium) to assess efficacy at inducing atrial flutter. A 20-pole halo catheter placed around the tricuspid annulus and a decapole catheter placed in the coronary sinus were used for mapping during initiation to determine type of flutter induced and the site of unidirectional block during initiation.
Results: Atrial flutter was induced in 52 (6.2%) of 838 attempted inductions. Of these, 33 were counterclockwise and 20 were clockwise. Of the 20 inductions resulting in clockwise flutter, 18 were from the trabeculated right atrium, whereas all the counterclockwise inductions were from the smooth right atrium. In all but the two inductions, the site of unidirectional block was identified between the os of the coronary sinus and the low lateral right atrium for both counterclockwise and clockwise flutter, in the same isthmus at which ablation is targeted.
Conclusions: Even in patients with clinical counterclockwise flutter, clockwise flutter is frequently induced before ablation and is dependent on the site of induction: Pacing from the smooth right atrium induces counterclockwise flutter, whereas pacing from the trabeculated right atrium induces clockwise flutter. The site of the unidirectional block during the initiation of either form of flutter is in the low right atrium isthmus.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/s0735-1097(96)00480-9 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Atrial Fibrillation and Flutter in a Contemporary Cohort of Patients With Myotonic Muscular Dystrophy.
JACC Clin Electrophysiol
January 2025
Section of Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Background: Literature on the prevalence and management of atrial arrhythmias in patients with myotonic muscular dystrophy type 1 (MMD1) or myotonic muscular dystrophy type 2 (MMD2) is limited.
Objectives: This study sought to describe incidence, prevalence, and predictors of atrial fibrillation (AF) and atrial flutter (AFL) in a contemporary cohort of patients with myotonic muscular dystrophy (MMD).
Methods: Associations between patient factors and incident AF/AFL were analyzed in patients with MMD referred for routine electrophysiology evaluation between January 2013 and September 2023.
Prediction of reduced left ventricular ejection fraction using atrial fibrillation or flutter electrocardiograms: A machine-learning study.
Digit Health
January 2025
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Objective: Although the evaluation of left ventricular ejection fraction (LVEF) in patients with atrial fibrillation (AF) or atrial flutter (AFL) is crucial for appropriate medical management, the prediction of reduced LVEF (<50%) with AF/AFL electrocardiograms (ECGs) lacks evidence. This study aimed to investigate deep-learning approaches to predict reduced LVEF (<50%) in patients with AF/AFL ECGs and easily obtainable clinical information.
Methods: Patients with 12-lead ECGs of AF/AFL and echocardiography were divided into those with LVEF <50% and ≥50%.
Pulmonary vein stenosis following radiofrequency pulmonary vein isolation: Presentation, diagnosis, and management using self-expandable, bare metal stents.
J Cardiol Cases
October 2024
Department of Cardiology, Mater Dei Hospital, Msida, Malta.
Unlabelled: Pulmonary vein (PV) stenosis is a rare complication following PV isolation (PVI) for atrial fibrillation. Despite the benefit of early intervention, screening is not conducted, emphasizing the importance of maintaining a high index of suspicion. Standardized management approaches are unavailable for this serious complication.
View Article and Find Full Text PDFGuideline-directed medical therapy rates in heart failure patients with reduced ejection fraction in a diverse cohort.
ESC Heart Fail
January 2025
Mid-Atlantic Permanente Research Institute, Mid-Atlantic Permanente Medical Group, Washington, DC, USA.
Aims: Guideline-directed medical therapy (GDMT) is recommended for all patients with heart failure with reduced ejection fraction (HFrEF). Despite this, little data exist describing GDMT use in diverse, real-world populations including the use of vasodilators, prescribed primarily to Black populations. We sought, among a diverse population of HFrEF patients, to determine (1) GDMT use rates and target dosing by medication class and (2) predictors of GDMT use and target dosing by medication class.
View Article and Find Full Text PDFAblation of slow activation areas in addition to pulmonary vein isolation improves the maintenance of the sinus rhythm in patients with persistent atrial fibrillation.
J Interv Card Electrophysiol
January 2025
Department of Cardiology, Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
Background: Slow activation areas, characterized by decreased conduction velocities in the left atrium, are commonly observed in patients with persistent atrial fibrillation (PeAF). However, it remains unclear whether the ablation of slow activation areas combined with pulmonary vein isolation (PVI) improves clinical outcomes in these patients.
Methods: This single-center retrospective study included patients who underwent catheter ablation for PeAF.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!