Cogprints

A Re-analysis of Our Current Understanding of Isthmus-Dependent Atrial Flutter: Some Gaps, Some Hypotheses

Nabar, Ashish (2001) A Re-analysis of Our Current Understanding of Isthmus-Dependent Atrial Flutter: Some Gaps, Some Hypotheses. [Journal (Paginated)]

Full text available as:

[img]HTML
53Kb

Abstract

The macro-reentrant circuit of isthmus-dependent atrial flutter (AFL) is located in the right atrium around the tricuspid annulus. High acute success and low recurrence rate makes isthmus ablation a definitive therapy for patients with only AFL. However, a review of the literature suggests that, different aspects of this macro-reentrant circuit are still not entirely understood, while new information continues to emerge. The aim of this article is to discuss some gaps in our “complete” understanding of isthmus-dependent AFL. Few hypotheses have been stated which are open to investigation.

Item Type:Journal (Paginated)
Keywords:Atrial Flutter; Isthmus-Dependent
Subjects:JOURNALS > Indian Pacing and Electrophysiology Journal
ID Code:4331
Deposited By:Indian Pacing and Electrophysiology, Journal
Deposited On:02 May 2005
Last Modified:11 Mar 2011 08:56

References in Article

Select the SEEK icon to attempt to find the referenced article. If it does not appear to be in cogprints you will be forwarded to the paracite service. Poorly formated references will probably not work.

1. Granada J, Uribe W, Chyou PH, Maassen K, Vierkant R, Smith PN, et al. Incidence and predictors of atrial flutter in the general population. J Am Coll Cardiol 2000;36:2242-2246

2. Crijns HJ, van Gelder IC, Tieleman RG, Brugemann J, de Kam PJ, Gosselink AT, et al. Long-term outcome of electrical cardioversion in patients with chronic atrial flutter. Heart 1997;77:56-61

3. Natale A, Newby KH, Pisano E, Leonelli F, Fanelli R, Potenza D, et al. Prospective randomized comparison of anti-arrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter. J Am Coll Cardiol 2000;35:1898-1904

4. Nabar A. Radiofrequency ablation for atrial flutter and atrial fibrillation: new insights. Academic Thesis, Maastricht University, The Netherlands, 1999

5. Smeets JLRM. Wave length of the cardiac impulse and reentrant arrhythmias. Academic Thesis, Maastricht University, The Netherlands, 1983

6. Arribas F, Lopez-Gill M, Cosio F, Nunez A. The upper link of human common atrial flutter circuit: definition by multiple endocardial recordings during entrainment. Pacin Clin Electrophysiol 1997;20:2924-2929

7. Friedman PA, Luria D, Fenton AM, Munger TM, Jahangir A, Shen WK et al., Global right atrial mapping of human atrial flutter: the presence of posteromedial (sinus venosa region) functional block and double potentials: a study in biplane fluoroscopy and intracardiac echocardiography. Circulation 2000;101:1568-1577

8. Olgin J, Kalman JM, Fitzpatrick AP, Lesh MD. Role of right atrial endocardial structures as barriers to conduction during human type I atrial flutter: activation and entrainment mapping guided by intra-cardiac echocardiography. Circulation 1997;96:3904-3912

9. Shah DC, Jais P, Haissaguerre M, Chouairi S, Takahashi A, Hocini M, et al. Three-dimensional mapping of the common atrial flutter circuit in the right atrium. Circulation 1997;96:3904-3912

10. Ndrepepa G, Zrenner B, Deisenhofer I, Karch M, Schneider M, Schreieck et al., Relationship between surface electrocardiogram characteristics and endocardial activation sequence in patients with typical atrial flutter. Z Kardiol 2000;89:527-537

11. Schmitt H, Weber S, Tillmans H, Waldecker B. Diagnosis and ablation of atrial flutter using a high resolution non contact mapping system. Pacin Clin Electrophysiol 2000;35:1276-1287

12. SippensGroenewegen A, Lesh MD, Roithinger, FX, Ellis WS, Steiner PR, Saxon LA et al., Body surface mapping of counterclockwise and clockwise typical atrial flutter: a comparative analysis with endocardial activation sequence mapping. J Am Coll Cardiol 2000;35:1276-1287

13. Feld GK, Mollerus M, Birgersdotter-Green U, Fujimura O, Bahnson TD, Boyce K, et al. Conduction velocity in the tricuspid valve-inferior vena cava isthmus is slower in patients with type I atrial flutter compared to those without a history of atrial flutter. J Cardiovasc Electrophysiol 1997;8:1338-1348

14. Poty H, Anselme F, Saoudi N. Inferior vena cava- tricuspid annulus isthmus is a critical site of unidirectional block during the induction of common atrial flutter. J Interv Card Electrophysiol 1998;2:57-69

15. Fenelon G, Brugada P. Unipolar waveforms and monophasic action potentials in the characterization of slow conduction in human atrial flutter. Pacin Clin Electrophysiol 1998;21:2580-2587

16. Waki K, Saito T, Becker AE. Right atrial flutter isthmus revisited: normal anatomy favors nonuniform anisotropic conduction. J Cardiovasc Electrophysiol 2000;11:90-94

17. Kinder C, Kall J, Kopp D, Rubenstein D, Burke M, Wilber D. Conduction properties of the inferior vena cava-tricuspid annular isthmus in patients with typical atrial flutter. J Cardiovasc Electrophysiol 1997;8:727-737

18. Rodriguez LM, Timmermans C, Nabar A, Hofstra L, Wellens HJJ. Bi-atrial activation in isthmus-dependent atrial flutter. Circulation 2001 (In press)

19. Roithinger FX, Cheng J, SippensGroenewegen A, Lee RJ, Saxon LA, Scheinman MM et al. Use of electroanatomical mapping to delineate transseptal atrial conduction in humans. Circulation 1999;100:1791-1797

20. Tsuchiya T, Okumura K, Tabuchi T, Iwasa A, Yasue H, Yamabe H. The upper turnover site in the reentry circuit of common atrial flutter. Am J Cardiol 1996;78:1439-1442

21. Tai CT, Chen SA, Chen YJ, Hsieh MH, Tsai CF, Chen CC, et al. Conduction properties of the crista terminalis in patients with typical atrial flutter: basis for a line of block in the reentrant circuit. J Cardiovasc Electrophysiol 1998;9:811-819

22. Schumacher B, Jung W, Schmidt H, Fischenbeck C, Lewalter T, Hagendorff A, et al. Transverse conduction capabilities of the crista terminalis in patients with atrial flutter and atrial fibrillation. J Am Coll Cardiol 1999;34:363-373

23. Yang Y, Chen J, Bochoeyer A, Hamdan MH, Kowal RC, Page R, et al. Atypical right atrial flutter patterns. Circulation 2001;103:3092-3098

24. Ellis WS, SippensGroenewegen A, Auslander DM, Lesh MD. The role of crista terminalis in atrial flutter and fibrillation: a computer modeling study. Ann Biomed Eng 2000;28:742-754

25. Anselme F, Savoure A, Cribier A, Saoudi N. Catheter ablation of typical AFL: a randomized comparison of 2 methods for determining complete bi-directional isthmus block. Circulation 2001;103:1434-1439

26. Scaglione M, Riccardi R, Calo L, Di Donna P, Lamberti F, Caponi D, et al. Typical atrial flutter ablation: conduction across the posterior region of the inferior vena cava orifice may mimic unidirectional isthmus block. J Cardiovasc Electrophysiol 2000;11:387-395

27. Lai LP, Lin JL, Lin LJ, Chen WJ, Ho YL, Tseng YZ, et al. New electrocardiographic criteria for the differentiation between counterclockwise and clockwise atrial flutter: correlation with electrophysiological study and radiofrequency catheter ablation. Heart 1998;80:80-85

28. Okumura K, Plumb VJ, Page PL, Waldo AL. Atrial activation sequence during atrial flutter in the canine pericarditis model and its effects on the polarity of the flutter wave in the electrocardiogram. J Am Coll Cardiol 1991;17:509-518

29. Schoels W, Offner B, Brachman J, Kuebler W, El-Sherif N. Circus movement atrial flutter in the canine pericarditis model: relation of characteristics of the surface electrocardiogram and conduction properties of the reentrant pathway. J Am Coll Cardiol 1994;23:799-808

30. Timmermans C, Rodriguez LM, Nabar A, Hofstra L, Pattiwael-Theunisz E, Wellens HJJ. Role of left atrial activation on the electrocardiographic flutter characteristics in isthmus-dependent counterclockwise atrial flutter. European Heart Journal 2001;22:435 (Abstract)

31. Saoudi N, Nair M, Abdelazziz A, Poty H, Daou A, Anselme F, et al. Electrocardiographic patterns and results of radiofrequency catheter ablation of clockwise type atrial flutter. J Cardiovasc Electrophysiol 1996;7:931-942

32. Chan DP, van Hare GF, Mackall JA, Carlson MD, Waldo AL. Importance of atrial flutter isthmus in post-operative intra-atrial reentrant tachycardia. Circulation 2000;102:1283-1289

33. Delacretaz E, Ganz LI, Soejima K, Friedman PL, Walsh EP, Triedman JK, et al. Multiple atrial macro-reentry circuits in adults with repaired congenital heart disease: entrainment mapping combined with three-dimensional electroanatomic mapping. J Am Coll Cardiol 2001;37:1665-1676

34. Akar JG, Kok LC, Haines DE, DiMarco JP, Mounsey JP. Coexistence of type I atrial flutter and intra-atrial re-entrant atrial tachycardia in patients with surgically corrected congenital heart disease. J Am Coll Cardiol 2001;38:377-384

35. Arenal A, Almendral J, Munoz R, Villacastin J, Merino JL, Palomo J, et al. Mechanism and location of atrial flutter in transplanted hearts: observations during transient entrainment from distant sites. J Am Coll Cardiol 1997;30:39-46

36. Hiasa G, Hamada M, Kodama K, Watanabe S, Ohtsuka T, Ikeda S, et al. Apical hypertrophic cardiomyopathy associated with life-threatening paroxysmal atrial flutter with a slow ventricular response: a case report. Jpn Circ J 2000;64:225-228

37. Luchsinger JA, Steinberg JS. Resolution of cardiomyopathy after ablation of atrial flutter. J Am Coll Cardiol 1998;32:205-210

38. Ishikawa T, Sumita S, Kikuchi M, Nakagawa T, Kosuge M, Kuji N, et al. Incidence of atrial flutter and atrial fibrillation in patients with implanted physiological pacemakers. Jpn Circ J 2000;64:505-509

39. Timmermans C. New insights in the electrical treatment of atrial fibrillation. Academic Thesis, Maastricht University, The Netherlands, 2000

40. Dijkman B. Arrhythmia management by the implantable dual chamber defibrillator – possibilities and limitations. Academic Thesis, Maastricht University, The Netherlands, 2001

41. Korte T, Niehaus M, Meyer O, Tebbenjohans J. Prospective evaluation of catheter ablation in patients with implantable cardioverter defibrillators and multiple inappropriate ICD therapies due to atrial fibrillation and type I atrial flutter. Pac Clin Electrophysiol 2001;24:1061-1066

42. Tunick PA, McElhinney L, Mitchell T, Kronzon I. The alternation between atrial flutter and atrial fibrillation. Chest 1992;101:34-36

43. Riva S, Tondo C, Carbucicchio C, Galimberti P, Fassini G, Della Bella P. Incidence and clinical significance of transformation of atrial fibrillation to atrial flutter in patients undergoing long-term antiarrhythmic drug treatment. Europace 1999;1:242-247

44. Paydak H, Kall JG, Burke MC, Rubenstein D, Kopp DE, Verdino RJ, et al. Atrial fibrillation after radiofrequency ablation of type I atrial flutter: time to onset, determinants, and clinical course. Circulation 1998;98:315-322

45. Huang DT, Monahan KM, Zimetbaum P, Papageorgiou P, Epstein LM, Josephson ME. Hybrid pharmacologic and ablative therapy: a novel and effective approach for the management of atrial fibrillation. J Cardiovasc Electrophysiol 1999;9:462-469

46. Stabile G, De Simone A, Turco P, La Rocca V, Nocerino P, Astarita C, et al. Response to flecainide infusion predicts long-term success of hybrid pharmacologic and ablation therapy in patients with atrial fibrillation. J Am Coll Cardiol 2001;37:1639-1644

47. Jung J, Hohenberg G, Heisel A, Strauss D, Schieffer H, Fries R. Discrimination of sinus rhythm, atrial flutter, and atrial fibrillation using bipolar endocardial signals. J Cardiovasc Electrophysiol 1998;9:689-695

48. Kumagai K, Tojo H, Noguchi H, Yasuda T, Tamari H, Matsumoto N, et al. Effects of cavotricuspid isthmus catheter ablation on paroxysmal atrial fibrillation. Jpn Heart J 2001;42:79-89

49. Konings KTS, Kirchoff CHJH, Smeets JLRM, Wellens HJJ, Penn OC, Allessie MA. High-density mapping of electrically induced atrial fibrillation in humans. Circulation 1994;89:1665-1680.

Metadata

Repository Staff Only: item control page