Ablation of Atypical Atrial Flutter Guided by the Use of Concealed Entrainment in Patients Without Prior Cardiac Surgery

Bogun, Frank; Bender, Birgit; Li, Yi‐Gang; Hohnloser, Stefan H.

doi:10.1111/j.1540-8167.2000.tb00312.x

Cited by 29 publications

(18 citation statements)

References 21 publications

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“…In Figure 4F, ECG analysis identified separate pre-and post-ablation mechanisms, guiding subsequent ablation. Furthermore, cycle-to-cycle variability of NIDAFL should be considered when interpreting post-pacing intervals during entrainment mapping and may contribute to the limitations of that technique in some studies (21). Study limitations.…”

Section: Greater Activation Variability In Nidafl Than Idaflmentioning

confidence: 97%

Separating non-isthmus- from isthmus-dependent atrial flutter using wavefront variability

Narayan¹,

Hassankhani²,

Feld³

et al. 2005

Journal of the American College of Cardiology

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Section: Greater Activation Variability In Nidafl Than Idaflmentioning

confidence: 97%

Separating non-isthmus- from isthmus-dependent atrial flutter using wavefront variability

Narayan¹,

Hassankhani²,

Feld³

et al. 2005

Journal of the American College of Cardiology

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“…In studies of atypical AFL with or without previous ablation for AF in the left atrium [1–5], RF ablation has mainly been performed by two approaches: linear lesions joining two anatomic barriers or silent areas, or both [1, 12] or, second, an electrophysiological approach targeting a critical isthmus presenting with a zone of slow conduction shown to be part of the circuit by pacing maneuvers [3, 4, 6]. Application of RF at this critical isthmus had been performed successfully with RF applications shorter than those usually needed for linear ablation [4, 6].…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency ablation of coronary sinus-dependent atrial flutter guided by fractionated mid-diastolic coronary sinus potentials

Tonet

Sisti

Amara

et al. 2010

J Interv Card Electrophysiol

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BackgroundThe efficacy of radiofrequency (RF) ablation of an uncommon coronary sinus (CS)-dependent atrial flutter (AFL) was evaluated using conventional electrophysiological criteria in a highly selected subset of patients with typical and atypical AFL.MethodsFourteen patients with atrial flutter (11 males, mean age 69 ± 9 years) without previous right or left atrial RF ablation were included. Heart disease was present in eight patients. Baseline ECG suggested typical AFL in 12 patients and atypical AFL in two. Mean AFL cycle length was 324 ± 64 ms at the time of RF ablation in the CS. Lateral right atrium activation was counterclockwise (CCW) in 13 patients and clockwise in one. CS activation was CCW in all. Criteria for CS ablation included the presence of CS mid-diastolic fractionated atrial potentials (APs) associated with concealed entrainment with a postpacing interval within 20 ms. Success was defined as termination of AFL and subsequent noninducibility.ResultsThe initial target for ablation was the cavotricuspid isthmus (CTI) in 11 patients and the CS with further CTI ablation in three. AP duration at the CS target site was 122 ± 33 ms, spanning 40 ± 12% of the AFL cycle length. CS ablation site was located 1–4 cm from the CS ostium. Ablation was successful in all patients. Mean time to AFL termination during CS ablation was 39 ± 52 s (<20 s in eight patients). No recurrence of ablated arrhythmia occurred during a follow-up of 18 ± 8 months.ConclusionsThe CS musculature is a critical part of some AFL circuits in patients with typical and atypical AFL. AFL can be terminated in patients with CS or CTI/CS AFL reentrant circuits by targeting CS mid-diastolic fragmented APs.

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“…However, the rate of success is not very different [20]. In patients with atypical AFl, conventional mapping is less successful [22]; the use of the CARTO mapping system has shown improved results in these patients [23].…”

Section: Interventional Proceduresmentioning

confidence: 99%

Atrial flutter

Garg

Feld

2001

Curr Treat Options Cardio Med

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Atrial flutter (AFl) is an arrhythmia resulting from reentry in a macroreentrant circuit, most commonly in the right atrium. Typical AFl uses the narrow isthmus of right atrial tissue between the tricuspid valve annulus and the inferior vena cava orifice as part of the macroreentrant circuit. The treatment of AFl is directed toward achieving the following four goals. 1) In the presence of AFl, adequate rate control is required, which can be achieved in most but not all patients by oral or intravenous digoxin, calcium channel blockers, or beta-blockers, alone or in combination. 2) Anticoagulation with warfarin should be considered in patients with recurrent AFl, especially those over 70 years of age, and those with a history of atrial fibrillation, stroke, or structural heart disease. 3) Conversion to sinus rhythm can be achieved in up to 70% of patients with intravenous ibutilide, but this should be reserved for patients with either normal hearts or only mild left ventricular dysfunction. Direct-current cardioversion is nearly 100% effective and is ideal for patients with left ventricular dysfunction. 4) Long-term maintenance of sinus rhythm may be achieved in up to 50% to 60% of patients by using antiarrhythmic drugs, including sotalol, amiodarone, dofetilide, propafenone, and flecainide, but with the potential for causing significant proarrhythmia and side effects. Radiofrequency catheter ablation may cure over 90% of patients with type 1 AFl (using the tricuspid valve to inferior vena cava isthmus), and from 70% to 90% of patients with atypical AFl. Newer mapping techniques, such as electroanatomic mapping, are likely to further reduce procedure time and improve success rates.

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Ablation of Atypical Atrial Flutter Guided by the Use of Concealed Entrainment in Patients Without Prior Cardiac Surgery

Abstract: Mapping and ablation of atypical AF is feasible if sites with CE can be identified. However, the clinical benefit of successful ablations in patients with atypical flutter appears to be limited.

Cited by 29 publications

References 21 publications

Separating non-isthmus- from isthmus-dependent atrial flutter using wavefront variability

Separating non-isthmus- from isthmus-dependent atrial flutter using wavefront variability

Radiofrequency ablation of coronary sinus-dependent atrial flutter guided by fractionated mid-diastolic coronary sinus potentials

Atrial flutter

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