Three-dimensional Mapping of the Common Atrial Flutter Circuit in the Right Atrium

Abstract

Interindividual variations occur in the right atrial circuit of common atrial flutter, with constant activation through the cavotricuspid isthmus. A variable zone of block forms the posterior limit. Fusion around the SVC can occur, and ascending medial septal activation does not follow a consistent pattern.

Activation Patterns and Conduction Velocity in Posterolateral Right Atrium During Typical Atrial Flutter Using an Electroanatomic Mapping System

“…5,6 The broad band of peritricuspid activation narrows as it enters the cavotricuspid isthmus, slows in the medial portion, ascends the septum and crosses the roof in front of the SVC or, more rarely fusing around it. 15 In the present study, electroanatomic mapping demonstrated that the activation pattern of typical CCW AFL is consistent with that described previously. 16 …”

Voltage and activation mapping. how the recording technique affects the outcome of catheter ablation procedures in patients with congenital heart disease

“…7,10,11 Radiofrequency current was applied for 60 seconds (maximum tip temperature set at 70°C, maximum output 50 W). Success was defined by (1) noninducibility of the clinical arrhythmia after the procedure, (2) establishment of a line of conduction block over the cavo-tricuspid isthmus (AFL patients), or (3) establishment of a line of conduction block between 2 anatomic boundaries (eg, scar areas in IART patients).…”

Contemporary Management of Atrial Flutter

“…In the circuit, a critical component of slow conduction is frequently present, often located in the isthmus of right atrial tissue, which is between the tricuspid annulus, the inferior vena cava, and the coronary sinus with the eustachian valve and ridge. 5,6 Occasionally, the circuit curves around a scar or surgical incision in the atrium or is confined to the left atrium. Endocardial activation mapping and stimulation studies are required to determine the circuit.…”

“…Endocardial activation mapping and stimulation studies are required to determine the circuit. 5,6 Of the different types of AFl shown in Figure 1, the typical, common, or type 1 flutter is the most frequent. In this type of flutter, right atrial activation rotates in a counterclockwise direction.…”