Abstract
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 [1]. 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 [2].
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Cosío FG, Arribas F, López-Gil M, Palacios J (1996) Atrial flutter mapping and ablation. I. Atrial flutter mapping. PACE 19: 841–853
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: 1839–1848
Saoudi N, Derumeaux G, Cribier A, Letac B (1991) The role of catheter ablation techniques in the treatment of classic (type 1) atrial flutter. PACE 14: 2022–2027
Cosio FG, Arribas F, López-Gil M, Gonzalez D (1996) Atrial flutter mapping and ablation II. Radiofrequency ablation of atrial flutter circuits. PACE 19: 965–975
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)
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: 1233–1240
Cosío FG, López-Gil M, Goicolea A, Arribas R, Barroso JL (1993) Radiofrequency ablation of the inferior vena cava-tricuspid valve isthmus in common atrial flutter. Am J Cardiol 71: 705–709
Kirkorian G, Moncada E, Chevalier P, Canu G, Claudel J-P, Bellon C, Lyon L, Touboul P (1994). Radiofrequency ablation of atrial flutter: efficacy of an anatomically guided approach. Circulation 90: 2804–2814
Lesh MD, Van Hare GF, Epstein LM, Fitzpatrick AP, Scheinman MM, Lee RJ, Kwasman MA, Grogin HR, Griffin JC (1994). Radiofrequency catheter ablation of atrial arrhythmias: results and mechanisms. Circulation 89: 1074–1089
Fischer B, Haïssaguerre M, Garrigues S, Poquet F, Gencel L, Clémenty J, Marcus FI (1995). Radiofrequency catheter ablation of common atrial flutter in 80 patients. J Am Coll Cardiol 25: 1365–1372
Philippon F, Plumb VJ, Epstein AE, Kay GN (1995). The risk of atrial fibrillation following radiofrequency catheter ablation of atrial flutter. Circulation 92: 430–435
Steinberg JS, Prasher S, Zelenkofske S, Ehlert FA (1995) Radiofrequency catheter ablation of atrial flutter: procedural success and long-term outcome. Am Heart J 130: 85–92
Saxon LA, Kalman JM, Olgin JE, Scheinman MM, Lee RJ, Lesh MD (1996) Results of radiofrequency catheter ablation for atrial flutter. Am J Cardiol 77: 1014–1016
Triedman JK, Saul JP, Weindling SN, Walsh EP (1995) Radiofrequency ablation of intraatrial reentrant tachycardia after surgical palliation of congenital heart disease. Circulation 91: 707–714
Baker BM, Cain ME, Baker BM, Lindsay BD, Bromberg BI, Frazier DW, Cain ME, Smith JM (1996) Catheter ablation of clinical intraatrial reentrant tachycardiac resulting from previous atrial surgery: localizing and transecting the critical isthmus. J Am Coll Cardiol 28: 411–417
Kalman JM, van Hare GF, Olgin J, Saxon LA, Stark SI, Lesh MD (1996) Ablation of `incisional’ reentrant atrial tachycardia complicating surgery for congenital heart disease: use of entrainment to define a critical isthmus of conduction. Circulation 93: 502–512
Rensma PL, Allessie MA, Lammers WJFP, Bonke FIM, Schalij MJ (1988) Length of excitation wave and susceptibility to reentrant atrial arrhythmias in normal conscious dogs. Circ Res 62: 395–410
Allessie MA, Lammers WJEP, Bonke FIM, Hollen J (1984) Intra-atrial reentry as a mechanism for atrial flutter induced by acetylcholine and rapid pacing in the dog. Circulation 70: 123–135
Cosío FG, Palacios J, Vidal JM, Cocina EG, Gómez-Sanchez MA, Tamargo L (1983) Electrophysiologic studies in atrial fibrillation. Slow conduction of premature impulses: a possible manifestation of the background for reentry. Am J Cardiol 51: 122–130
Buxton AE, Waxman HL, Marchlinski FE, Josephson ME (1984) Atrial conduction: effects of extrastimuli with and without atrial dysrhythmia. Am J Cardiol 54: 755–761
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: 175–191
Saffitz JE, Kanter L, Green KG, Tolley TK, Beyer EC (1994) Tissue-specific determinants of anisotropic conduction velocity in canine atrial and ventricular myocardium. Circ Res 74: 1065–1070
Yamashita T, Nakajima T, Hazama H, Hamada E, Murakawa Y, Sawada K, Ornata M (1995) Regional differences in transient outward current density and inhomogeneities of repolarization in rabbit right atrium. Circulation 92: 3061–3069
Olshansky B, Okumura K, Hess PG, Waldo AL (1990) Demonstration of an area of slow conduction in human atrial flutter. J Am Coll Cardiol 16: 1639–1648
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)
Olshansky B, Okumura K, Henthorn RW, Waldo AL (1990) Characterization of double potentials in human atrial flutter: studies during transient entrainment. J Am Coll Cardiol 15: 833–841
Saumarez RC, Parker J, Camm J (1992) Geometrically accurate mapping of the atrioventricular node region during surgery. J Am Coll Cardiol 19: 601–606
Cosío FG, López-Gil M, Arribas F, Goicolea A, Palacios J, Núnez A (1994) The mechanisms of entrainment of human common flutter studied with multiple endocardial recordings. Circulation 89: 2117–2126
Racker DK, Ursell PC, Hoffman BF (1991) Anatomy of the tricuspid annulus: circumferential myofibers as the structural basis for atrial flutter in a canine model. Circulation 84: 841–851
Haïssaguerre M, Marcus FI, Fischer B, Clémenty J (1994) Radiofrequency catheter ablation in unusual mechanisms of atrial fibrillation: report of three cases. J Cardiovasc Electrophysiol 5: 743–751
Wijffels MCEF, Kirchhof CJHJ, Dorland R, Allessie MA (1995) Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation 92: 1954–1968
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)
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)
Suttorp MJ, Kingma JH, Koomen EM, Van’t Hof A, Tijssen JP, Kong IL (1993) Recurrence of paroxysmal AF of flutter after successful cardioversion in patients with normal left ventricular function. Am J Cardiol 71: 710–713
Crijns HJGM, Van Gelder IC, Ticleman RG, Brügemann J, De Kam PJ, Gosselink ATM, Bink-Boelkens MThE, Lie KI (1997) Long-term outcome of electrical cardioversion in patients with chronic atrial flutter. Heart 77: 56–61
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: 407–424
Feld G, Fujimura 0, Green U, Mazzola F (1955) Radiofrequency catheter ablation of human type 1 atrial flutter - Comparison of results with 8 mm versus 4 mm tip ablation catheter. J Am Coll Cardiol 25 [Suppl A]: 169 (abstr)
Poty H, Saoudi N, Abdel Aziz A (1995) Radiofrequency ablation of type 1 atrial flutter: prediction of late success by electrophysiological criteria. Circulation 92: 1389–1392
Poty H, Saoudi N, Nair M, Anselme F, Letac B (1996) Radiofrequency catheter ablation of atrial flutter: further insights into the various types of isthmus block. Application to ablation during sinus rhythm. Circulation 94: 3204–3213
Cauchemez B, Haïssaguerre M, Fischer B, Thomas O, Clementy J, Coumel P (1996) Electrophysiological effects of catheter ablation of inferior vena cava-tricuspid annulus isthmus in common atrial flutter. Circulation 93: 284–294
Schartzman D, Callans DJ, Gottlieb CD, Dillon SM, Movsowitz C, Marchlinski FE (1996) Conduction block in the inferior vena caval-tricuspid valve isthmus: association with outcome of radiofrequency ablation of type I atrial flutter. J Am Coll Cardiol 28: 1519–531
Movsowitz C, Callans DJ, Schwartzman D, Gottlieb C, Marchlinski F (1996) The results of atrial flutter ablation in patients with and without a history of atrial fibrillation. Am J Cardiol 78: 93–96
Fenelon G, Wijns W, Adries E, Brugada P (1996) Tachycardiomyopathy: mechanisms and clinical implications. PACE 19: 95–106
Cosío FG, Arribas F, López Gil M (1996) Ablación con catéter del flutter y la fibrilación auricular. Rev Esp Cardiol 49 (Suppl 2): 55–63
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1998 Springer-Verlag Italia
About this chapter
Cite this chapter
Cosío, F.G., López-Gil, M., Arribas, E., Goicolea, A. (1998). Atrial Flutter Ablation: Long-Term Results with Standard Approach after Eight Years of Experience. In: Raviele, A. (eds) Cardiac Arrhythmias 1997. Springer, Milano. https://doi.org/10.1007/978-88-470-2288-1_69
Download citation
DOI: https://doi.org/10.1007/978-88-470-2288-1_69
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-2290-4
Online ISBN: 978-88-470-2288-1
eBook Packages: Springer Book Archive