Atrial Flutter Ablation: Long-Term Results with Standard Approach after Eight Years of Experience
In the last 10 years there have been important advances in the understanding of atrial flutter mechanisms, that have led to new therapies aimed at circuit ablation. Mapping and entrainment studies have established that common flutter (FL) is due to a large reentry circuit in the right atrium, encircling superior and inferior vena cava in a “counterclockwise” direction (down the anterior wall, up the septal wall). A less common form of FL, usually producing positive looking waves in the inferior leads, is due to reentry in the same circuit in the opposite (“clockwise”) direction . The crista terminalis is thought to play a crucial role in both cases, by blocking transverse conduction between the venae cavae orifices, on the bases of anisotropic conduction, and other anatomic obstacles, such as the Eustachian ridge, maybe important to direct activation in other areas .
KeywordsAtrial Fibrillation Radiofrequency Ablation Atrial Flutter Right Atrium Sick Sinus Syndrome
Unable to display preview. Download preview PDF.
- 2.Olgin JE, Kalman JM, Fitzpatrick AP, Lesh MD (1995) Role of right atrial structures as barriers to conduction during human type I atrial flutter. Activation and entrainment mapping guided by intracardiac echocardiography. Circulation 92: 1839–1848Google Scholar
- 5.Cosio FG, López-Gil M, Goicolea A, Barroso JL, Karoni A (1991) Radiofrequency modification of the critical isthmus in atrial flutter. Eur Heart J 12: 369 (abstr)Google Scholar
- 6.Feld GK, Fleck RP, Chen P-S, Boyce K, Bahnson TD, Stein JB, Calisi CM, Ibarra M (1992) 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. Circulation 86: 1233–1240PubMedCrossRefGoogle Scholar
- 21.Spach MS, Miller WT, Dolber PC, Kootsey JM, Sommer JR, Mosher CE (1982) The functional role of structural complexities in the propagation of depolarization in the atrium of the dog. Cardiac conduction disturbances due to discontinuities of effective axial resistivity. Circ Res 50: 175–191PubMedCrossRefGoogle Scholar
- 25.Kinder C, Burke M, Kali J, Kopp D, Rubenstein D, Wilber D (1996) Conduction properties of the inferior vena cava-tricuspid annular isthmus in atrial flutter. PACE 19: 578 (abstr)Google Scholar
- 32.Turitto G, Rao S, Salciccioli L, Abordo M, El-Sherif N (1994) Electrocardiographic and echocardiographic correlates of atrial flutter and fibrillation. Circulation 90 [Suppl I1: 338 (abstr)Google Scholar
- 33.Núnez A, Arribas F, López-Gil M, Puigdueta B, Palacios J, Cosío FG (1995) A study of the mechanism of atrial flutter and atrial tachycardia in adults by mapping and pacing. PACE 18: 803 (abstr)Google Scholar
- 36.Nakagawa H, Lazzara R, Khastgir T, Beckman KJ, McClelland JH, Imai S, V. Pitha J, MD, Becker AE, Arruda M, Gonzalez MD, Widman LE, Rome M, Neuhauser J, Wang X, Calame JD, Goudeau MD, Jackman WM (1996) Role of the tricuspid annulus and the eustachian valve/ridge on atrial flutter: relevance to catheter ablation of the septal isthmus and a new technique for rapid identification of ablation success. Circulation 94: 407–424PubMedCrossRefGoogle Scholar
- 44.Cosío FG, Arribas F, López Gil M (1996) Ablación con catéter del flutter y la fibrilación auricular. Rev Esp Cardiol 49 (Suppl 2): 55–63Google Scholar