Atrial Flutter: an Update

Cosío, Francisco G.; Pastor, Agustı́n; Núñez, Ambrosio; Magalhães, Ana Paula Moreira; Awamleh, Paula

doi:10.1016/s1885-5857(07)60047-4

Cited by 29 publications

(23 citation statements)

References 92 publications

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“…This is in contrast to radiofrequency ablation, which can be very painful in this region. 3,10 In our study, the long-term results were comparable to those obtained after radiofrequency ablation reporting up to 15% of AFL recurrences after assessment of acute bidirectional isthmus conduction block. 4 -6,11 Resumption of AFL occurred mostly in the first months after radiofrequency ablation.…”

Section: Discussionsupporting

confidence: 83%

Catheter-Based Cryoablation Permanently Cures Patients With Common Atrial Flutter

et al. 2004

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Background-Cryoablation (cryo) has a high success rate in the short-term treatment of atrial flutter (AFL), but evidence of long-term efficacy is lacking. The present study reports the long-term effect of cryo of the cavotricuspid isthmus (CTI) in patients with common AFL. Methods and Results-Thirty-five consecutive patients (28 men; mean age, 53 years) underwent cryo of the CTI. In 34 patients, the AFL had a counterclockwise rotation (cycle length, 242Ϯ43 ms). Eleven patients had structural heart disease. Cryo was performed with a 10F catheter with a 6-mm-tip electrode (CryoCor). Applications (3 to 5 minutes each) were delivered by use of a point-by-point technique to create the ablation line. The acute end point of the procedure was creation of bidirectional isthmus conduction block and noninducibility of AFL. A median of 14 applications (range, 4 to 30) at 10 sites (range, 4 to 19) was given along the CTI with a mean temperature of Ϫ80.0Ϯ5.0°C. Mean fluoroscopy and procedure times were 40Ϯ26 minutes and 3.2Ϯ1.3 hours, respectively. Of the 35 patients, 34 were acutely successfully ablated (97%). After a mean follow-up of 17.6Ϯ6.2 months (range, 9.6 to 26.1 months), 31 patients (89%) did not have recurrence of AFL. Three of the 4 patients with recurrence had a second successful procedure. One patient had transient ST elevation in the inferior leads during cryoapplication. Conclusions-Cryo produces permanent bidirectional isthmus conduction block of the CTI. Short-and long-term success rates are comparable to those for radiofrequency ablation.

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Section: Discussionsupporting

confidence: 83%

Catheter-Based Cryoablation Permanently Cures Patients With Common Atrial Flutter

et al. 2004

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“…One possible speculation is that resolution of AF by ablation involves different anatomical targets (i.e., pulmonary veins, highly fractionated areas, ganglionated plexi, etc. ), while AFL has a unique target area, the cavotricuspid isthmus [18,19]. Persistence of the modulator (SA) after AF ablation may predispose new triggers to regenerate AF, while in patients with AFL, this may be prevented by a bidirectional block at the isthmus level.…”

Section: Discussionmentioning

confidence: 99%

“…This rate is slightly higher than what has been previously reported. Traditionally, recurrence rates of AFL after catheter ablation have been <10% [18]. However, this value has more recently been refined with bidirectional cavotricuspid isthmus block as the endpoint (3-5%) [19].…”

Section: Discussionmentioning

confidence: 99%

Sleep apnea does not predict atrial flutter recurrence after atrial flutter ablation

Oosten

Furqan

Redfearn

et al. 2011

J Interv Card Electrophysiol

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“…With the progress made in catheter technology such as 8-mm and irrigated-tip catheters, and the use of more stringent electrophysiological endpoints such as bidirectional isthmus block, radiofrequency ablation of atrial flutter has become a routine procedure with high success of 90-95%. It is also a quick procedure with very low complication rates [3]. Whilst catheter ablation carries a class I indication in the most recent international guidelines for long-term management of patients with either recurrent, drug-refractory or poorly tolerated atrial flutter, it is not indicated in the management of acute atrial flutter [2].…”

Section: Discussionmentioning

confidence: 99%

“…Whilst direct current cardioversion is extremely effective in terminating acute atrial flutter, it is not curative and the existing treatment paradigm for recurrent atrial flutter, particularly when associated with haemodynamic compromise, is less than ideal. Radiofrequency ablation of atrial flutter is a potentially curative technique with short procedural times, high success and very low complication rates in elective cases, but its application to intensive care patients is not well defined [2,3]. We describe a patient with poorly tolerated atrial flutter for which various treatment strategies were not only ineffective but resulted in clinical deterioration before the flutter was successfully treated by radiofrequency ablation.…”

mentioning

confidence: 99%

Role of electrophysiological study and ablation in the management of recurrent atrial flutter associated with haemodynamic compromise in a critically ill patient

Kojodjojo¹,

Kanagaratnam²,

Davies³

et al. 2005

Anaesthesia

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SummaryAtrial flutter is a common arrhythmia. In the critical care setting, the arrhythmia may present in any patient, but it is most commonly seen in patients with impaired ventricular function, valvular disease, atrial dilatation or after cardiac surgery. We present a 68-year-old lady with recurrent poorly tolerated atrial flutter that was resistant to multiple pharmacological interventions and complicated by cardiogenic shock following direct current cardioversion. The flutter was successfully cured with radiofrequency ablation and was followed by an immediate improvement in her haemodynamic status. We review the management of acute atrial flutter and discuss the role of electrophysiologically guided ablation. Atrial flutter is a common arrhythmia in critically ill patients [1]. Whilst direct current cardioversion is extremely effective in terminating acute atrial flutter, it is not curative and the existing treatment paradigm for recurrent atrial flutter, particularly when associated with haemodynamic compromise, is less than ideal. Radiofrequency ablation of atrial flutter is a potentially curative technique with short procedural times, high success and very low complication rates in elective cases, but its application to intensive care patients is not well defined [2,3]. We describe a patient with poorly tolerated atrial flutter for which various treatment strategies were not only ineffective but resulted in clinical deterioration before the flutter was successfully treated by radiofrequency ablation. Case reportA 68-year-old lady was admitted with a 2-month history of intermittent central chest pain, exertional dyspnoea, orthopnoea and peripheral oedema. She had wellcontrolled insulin-treated type 2 diabetes mellitus and hypertension, but no history of ischaemic heart disease.Blood pressure on admission was 105 ⁄ 60 mmHg with a resting tachycardia of 157 beats.min )1. The jugular venous pressure was elevated and mild peripheral oedema was present. A pan-systolic murmur and third heart sound were audible. A chest radiograph revealed cardiomegaly but not overt pulmonary oedema. Blood tests confirmed normal thyroid function, serum electrolytes, liver and renal function tests and blood count. A 12-lead electrocardiogram (ECG) showed a regular narrow-complex tachycardia. Adenosine was administrated with transient atrio-ventricular nodal block, during which the arrhythmia continued, revealing regular flutter waves. Transthoracic echocardiography demonstrated moderate mitral and tricuspid regurgitation with a poorly contracting left ventricle.A working diagnosis of atrial flutter with rate-related symptoms on the background of dilated and severe global cardiac dysfunction was made. Oral metoprolol 25 mg tds was added in an attempt to control her ventricular rate. Intravenous furosemide 80 mg and enoxaparine 150 units.kg )1 were also prescribed. The following day, she remained in atrial flutter with a heart rate of

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Atrial Flutter: an Update

Cited by 29 publications

References 92 publications

Catheter-Based Cryoablation Permanently Cures Patients With Common Atrial Flutter

Catheter-Based Cryoablation Permanently Cures Patients With Common Atrial Flutter

Sleep apnea does not predict atrial flutter recurrence after atrial flutter ablation

Role of electrophysiological study and ablation in the management of recurrent atrial flutter associated with haemodynamic compromise in a critically ill patient

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