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Catheter ablation of Atrial Incisional Tachycardia mistaken for Atrial flutter
Ottaviano L,Muto C,Carreras G,Canciello M
Indian Pacing and Electrophysiology Journal , 2007,
Abstract: Incisional sustained tachycardias are frequent in patients who have undergone a surgical repair of interatrial defect. A 43-year-old woman with drug refractory, highly symptomatic, persistent atrial tachycardia in the last year, was referred to our unit for catheter ablation. The patient had undergone a cardiac operation for repairing interatrial secundum ostium type defect with a patch five years before. A previous radiofrequency ablation procedure had been performed for common atrial flutter. We describe a case of incisional atrial tachycardia ablation guided by the new EnSite NavX system equipped with a new electroanatomic mapping system.
Electrophysiological Mechanisms of Atrial Flutter  [cached]
Ching- Tai Tai,Shin-Ann Chen
Indian Pacing and Electrophysiology Journal , 2006,
Abstract: Atrial flutter (AFL) is a common arrhythmia in clinical practice. Several experimental models such as tricuspid regurgitation model, tricuspid ring model, sterile pericarditis model and atrial crush injury model have provided important information about reentrant circuit and can test the effect of antiarrhythmic drugs. Human atrial flutter has typical and atypical forms. Typical atrial flutter rotates around tricuspid annulus and uses the crista terminalis and sometimes sinus venosa as the boundary. The IVC-tricuspid isthmus is a slow conduction zone and the target of radiofrequency ablation. Atypical atrial flutter may arise from the right or left atrium. Right atrial flutter includes upper loop reentry, free wall reentry and figure of eight reentry. Left atrial flutter includes mitral annular atrial flutter, pulmonary vein-related atrial flutter and left septal atrial flutter. Radiofrequency ablation of the isthmus between the boundaries can eliminate these arrhythmias.
Novel method to evaluate the conduction velocity and conducting area during isthmus-dependent atrial flutter  [cached]
Alim Erdem,Ebru G?lcük,Zekeriya Kü?ükdurmaz,Ritsushi Kato
Anadolu Kardiyoloji Dergisi , 2011,
Abstract: Objective: The difference of the conduction velocity (CV) around the tricuspid valve annulus between the counter-clockwise (CCW) atrial flutter and the clockwise (CW) atrial flutter has not been well clarified. This study was undertaken to evaluate the CV and the conducting area (CA) per millisecond around the tricuspid valve annulus using the electroanatomical mapping.Methods: The electroanatomical mapping was performed during the tachycardia for 30 consecutive patients (mean age: 61±16 years) with isthmus-dependent atrial flutter (CCW, 25; CW, 5). We measured the CV and the CA of five divided areas of the right atrium, that is, upper septum (US), lower septum (LS), isthmus (I), upper lateral wall (UL) and lower lateral wall (LL) using the novel measurement method in the isochronal map. Statistical differences of these data between the two groups were assessed by the Student’s t-test and one-way analysis of variance methods.Results: In total, the CV of the LS was significantly slower than other areas (m/sec: US, 0.57±0.18; LS, 0.43±0.18; UL, 0.60±0.26; LL, 0.53±0.20; I, 0.50±0.17; p<0.05) and the CA of the US and UL were significantly larger than other areas (mm2/sec: US, 34.5±16.2; LS, 16.2±9.5; UL, 40.0±14.1; LL, 27.0±17.0; I, 16.8±8.5; p<0.0001). There was no significant difference between the CCW and the CW atrial flutters in terms of the CV and the CA of equally divided five areas.Conclusion: In both of the CCW and the CW atrial flutters, the CV of the LS was significantly slower than other areas and the CA of the lower atrium was significantly smaller than the upper atrium.
Pharmacological cardioversion for atrial fibrillation and flutter  [cached]
Cordina J,Mead G
Indian Pacing and Electrophysiology Journal , 2006,
Abstract: Atrial fibrillation is the commonest cardiac dysrhythmia. It is associated with significant morbidity and mortality. There are two approaches to the management of atrial fibrillation: controlling the ventricular rate or converting to sinus rhythm in the expectation that this would abolish its adverse effects. The objective of this review was to assess the effects of pharmacological cardioversion of atrial fibrillation in adults on the annual risk of stroke, peripheral embolism, and mortality. We made a thorough search for existing evidence in the following databases: the Cochrane Controlled Trials Register (Issue 3, 2002), MEDLINE (2000 to 2002), EMBASE (1998 to 2002), CINAHL (1982 to 2002), Web of Science (1981 to 2002). We also handsearched the following journals: Circulation (1997 to 2002), Heart (1997 to 2002), European Heart Journal (1997-2002), Journal of the American College of Cardiology (1997-2002) and selected abstracts published on the web site of the North American Society of Pacing and Electrophysiology (2001, 2002). We selected trials based on the following criteria: randomised controlled trials or controlled clinical trials of pharmacological cardioversion versus rate control in adults (>18 years) with acute, paroxysmal or sustained atrial fibrillation or atrial flutter, of any duration and of any aetiology. We identified two completed studies AFFIRM (n=4060) and PIAF (n=252). We found no difference in mortality between rhythm control and rate control - relative risk 1.14 (95% confidence interval 1.00 to 1.31). Both studies show significantly higher rates of hospitalisation and adverse events in the rhythm control group and no difference in quality of life between the two treatment groups. In AFFIRM there was a similar incidence of ischaemic stroke, bleeding and systemic embolism in the two groups. Certain malignant dysrhythmias were significantly more likely to occur in the rhythm control group. There were similar scores of cognitive assessment in both groups. In PIAF, cardioverted patients enjoyed an improved exercise tolerance but there was no overall benefit in terms of symptom control or quality of life. There is no evidence that pharmacological cardioversion of atrial fibrillation to sinus rhythm is superior to rate control. Rhythm control is associated with more adverse effects and increased hospitalisation. It does not reduce the risk of stroke. These conclusions cannot be generalised to all people with atrial fibrillation as most of the patients included in these studies were relatively older (>60 years) with significant cardiova
Atrial Flutter following a Wasp Sting  [cached]
Fisher B,Antonios T
Journal of Postgraduate Medicine , 2003,
Abstract: Wasp stings have been associated with a wide variety of local and systemic reactions including, rarely, tachyarrhythmias. We discuss a case of atrial flutter occurring in a 64-year-old man following a single sting in the absence of anaphylaxis. The pathogenesis is discussed and the literature reviewed.
Atrial flutter: contemporary possibilities of diagnosis and treatment  [cached]
Yu.A. Bunin
Rational Pharmacotherapy in Cardiology , 2011,
Abstract: Diagnosis and treatment of atrial flutter (AF) is an important clinical task. Epidemiological data, electrophysiological mechanisms and updated classification of AF are presented as well as treatment algorithm that is suggested by leading experts. Two strategies of AF therapy are shown: "rhythm control" and "rate control". Author paid attention that ventricular rate reduction in AF is more difficult task than this in atrial fibrillation. Indications for different AF treatments are discussed: pharmacotherapy, pacing and cardioversion as well as surgical methods.
Isthmus Dependent Atrial Flutter Cycle Length Correlates with Right Atrial Cross-Sectional Area
Kousik Krishnan,Akshay Gupta,Sean M. Halleran,Dave Chawla
Indian Pacing and Electrophysiology Journal , 2009,
Abstract: Background: Right atrial flutter cycle length can prolong in the presence of antiarrhythmic drug therapy. We hypothesized that the cycle length of right atrial isthmus dependent flutter would correlate with right atrial cross-sectional area measurements. Methods: 60 patients who underwent ablation for electrophysiologically proven isthmus dependent right atrial flutter, who were not on Class I or Class III antiarrhythmic drugs and had recent 2-dimensional echocardiographic data comprised the study group. Right atrial length and width were measured in the apical four chamber view. Cross-sectional area was estimated by multiplying the length and width. 35 patients had an atrial flutter rate ≥250 bpm (Normal Flutter Group) and 25 patients had an atrial flutter rate < 250 bpm (Slow Flutter Group). Results: Mean atrial flutter rate was 283 bpm in the normal flutter group and 227 bpm in the slow flutter group. Mean atrial flutter cycle length was 213 ms in the Normal Flutter Group and 265 ms in the Slow Flutter Group (p<0.0001). Mean right atrial cross sectional area was 1845 mm2 in the Normal Flutter group and 2378 mm2 in the Slow Flutter Group, (p< 0.0001). Using linear regression, CSA was a significant predictor of cycle length (β =0.014 p = 0.0045). For every 1 mm2 increase in cross-sectional area, cycle length is 0.014 ms longer.Conclusion: In the absence of antiarrhythmic medications, right atrial cross sectional area enlargement correlates with atrial flutter cycle length. These findings provide further evidence that historical rate-related definitions of typical isthmus dependent right atrial are not mechanistically valid.
Radiofrequency catheter ablation of type 1 atrial Flutter
Yamini Sharif A,Moghaddam M
Acta Medica Iranica , 2000,
Abstract: It has been well - established that common atrial flutter is due to intraatrial macroreentry and its reentry circuit locates in the right atrium. This reentry circuit has been characterized to involve an area of slow conduction identifiable electrophysiologically at the low posteroseptal right atrium and anatomical narrow isthmus snrrounded by the inferior vena capa, coronary sinus astium and tricuspid valve annulus. We performed radiofrequency catheter ablation for common atrial futter using anatomical approach in one patient. In this report, we discuss the efficacy of catheter ablative therapy and its results in our patient.
Healthcare Utilization and Clinical Outcomes after Catheter Ablation of Atrial Flutter  [PDF]
Thomas A. Dewland, David V. Glidden, Gregory M. Marcus
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0100509
Abstract: Atrial flutter ablation is associated with a high rate of acute procedural success and symptom improvement. The relationship between ablation and other clinical outcomes has been limited to small studies primarily conducted at academic centers. We sought to determine if catheter ablation of atrial flutter is associated with reductions in healthcare utilization, atrial fibrillation, or stroke in a large, real world population. California Healthcare Cost and Utilization Project databases were used to identify patients undergoing atrial flutter ablation between 2005 and 2009. The adjusted association between atrial flutter ablation and healthcare utilization, atrial fibrillation, or stroke was investigated using Cox proportional hazards models. Among 33,004 patients with a diagnosis of atrial flutter observed for a median of 2.1 years, 2,733 (8.2%) underwent catheter ablation. Atrial flutter ablation significantly lowered the adjusted risk of inpatient hospitalization (HR 0.88, 95% CI 0.84–0.92, p<0.001), emergency department visits (HR 0.60, 95% CI 0.54–0.65, p<0.001), and overall hospital-based healthcare utilization (HR 0.94, 95% CI 0.90–0.98, p = 0.001). Atrial flutter ablation was also associated with a statistically significant 11% reduction in the adjusted hazard of atrial fibrillation (HR 0.89, 95% CI 0.81–0.97, p = 0.01). Risk of acute stroke was not significantly reduced after ablation (HR 1.09, 95% CI 0.81–1.45, p = 0.57). In a large, real world population, atrial flutter ablation was associated with significant reductions in hospital-based healthcare utilization and a reduced risk of atrial fibrillation. These findings support the early use of catheter ablation for the treatment of atrial flutter.
Syncope: As a Rare Presenting Feature of Atrial Flutter
Y Mahmoody,MA Babaee Beygi,MV Jorat
Iranian Cardiovascular Research Journal , 2009,
Abstract: A 42-years-old woman presented with palpitation. Her symptoms aggravated since 2 years ago, and developed palpitation and syncope during its last six months. Her symptoms continued despite the medical therapy. During heart monitoring in CCU, she developed a narrow QRS complex tachycardia with rate of 150 beats/min. After injection of adenosine, ventricular rate slowed down and the flutter waves were appeared. In electrophysiology study (EPS), reverse atrial flutter was induced. Bidirectional cavotricuspid isthmus block by application of radiofrequency energy was done for her. No arrhythmia was induced after radiofrequency ablation. The patient was discharged and during follow up is free of symptoms.
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