(Circulation. 2001;103:3092.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Atypical Right Atrial Flutter Patterns
Presented in abstract form at the 21st Annual Scientific Sessions of North American Society of Pacing and Electrophysiology, Washington, DC, May 19, 2000, and published in abstract form (Pacing Clin Electrophysiol. 2000;23:579).
From the Cardiovascular Research Institute and Section of Cardiac Electrophysiology (Y.Y., J.C., A.B., R.J.L., P.R.S., L.A.S., M.D.L., G.W.M., M.M.S.), University of California, San Francisco, and the University of Texas Southwestern Medical Center and the Dallas Veterans Affairs Medical Center (M.H.H., R.C.K., R.P.), Dallas, Tex.
Correspondence to Melvin M. Scheinman, MD, Cardiac Electrophysiology, University of California, San Francisco, 500 Parnassus Ave, MU East 4S, Box 1354, San Francisco, CA 94143-1354. E-mail scheinman{at}medicine.ucsf.edu
Background—The purpose of our study was to define the incidence and mechanisms of atypical right atrial flutter.
Methods and Results—A total of 28 (8%) of 372 consecutive patients with atrial flutter (AFL) had 36 episodes of sustained atypical right AFL. Among 24 (67%) of 36 episodes of lower loop reentry (LLR), 13 (54%) of 24 episodes had early breakthrough at the lower lateral tricuspid annulus, whereas 11 (46%) of 24 episodes had early breakthrough at the high lateral tricuspid annulus, and 9 (38%) of 24 episodes showed multiple annular breaks. Bidirectional isthmus block resulted in elimination of LLR. A pattern of posterior breakthrough from the eustachian ridge to the septum was observed in 4 (14%) of 28 patients. Upper loop reentry was observed in 8 (22%) of 36 episodes and was defined as showing a clockwise orientation with early annular break and wave-front collision over the isthmus. Two patients had atypical right AFL around low voltage areas ("scars") in the posterolateral right atrium.
Conclusions—Atypical right AFL is most commonly associated with an isthmus-dependent mechanism (ie, LLR or subeustachian isthmus breaks). Non–isthmus-dependent circuits include upper loop reentry or scar-related circuits.
Key Words: electrophysiology • atrial flutter • catheter ablation • mapping • tachycardia
This article has been cited by other articles:
 |
|
 |
|
  G. Barbato, V. Carinci, C. Tomasi, V. Frassineti, M. Margheri, and G. Di Pasquale Is the electrocardiography a reliable tool for identifying patients with isthmus-dependent atrial flutter? Europace, July 1, 2009; (2009) eup166v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Liew, A. Catanchin, E. R. Behr, and D. Ward Use of non-contact mapping in the treatment of right atrial tachycardias in patients with and without congenital heart disease Europace, August 1, 2008; 10(8): 972 - 981. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Medi and J. M. Kalman Prediction of the atrial flutter circuit location from the surface electrocardiogram Europace, July 1, 2008; 10(7): 786 - 796. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. L. Waldo and G. K. Feld Inter-Relationships of Atrial Fibrillation and Atrial Flutter: Mechanisms and Clinical Implications J. Am. Coll. Cardiol., February 26, 2008; 51(8): 779 - 786. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Maury, A. Duparc, A. Hebrard, M. El Bayomy, and M. Delay Prevalence of typical atrial flutter with reentry circuit posterior to the superior vena cava: Use of entrainment at the atrial roof Europace, February 1, 2008; 10(2): 190 - 196. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. P. Brown, D. E. Krummen, G. K. Feld, and S. M. Narayan Using Electrocardiographic Activation Time and Diastolic Intervals to Separate Focal From Macro-Re-Entrant Atrial Tachycardias J. Am. Coll. Cardiol., May 15, 2007; 49(19): 1965 - 1973. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Huang, C.-T. Tai, Y.-J. Lin, B.-H. Huang, K.-T. Lee, S. Higa, Y. Yuniadi, Y.-J. Chen, S.-L. Chang, L.-W. Lo, et al. Substrate Mapping to Detect Abnormal Atrial Endocardium With Slow Conduction in Patients With Atypical Right Atrial Flutter J. Am. Coll. Cardiol., August 1, 2006; 48(3): 492 - 498. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y.-J. Lin, C.-T. Tai, T. Kao, H.-W. Tso, J.-L. Huang, S. Higa, Y. Yuniadi, B.-H. Huang, T.-Y. Liu, P.-C. Lee, et al. Electrophysiological Characteristics and Catheter Ablation in Patients With Paroxysmal Right Atrial Fibrillation Circulation, September 20, 2005; 112(12): 1692 - 1700. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Nabar, C. Timmermans, A. Medeiros, K. Polymeropoulous, H.J.G.M. Crijns, and L.M. Rodriguez Radiofrequency ablation of atrial arrhythmias after previous open-heart surgery Europace, January 1, 2005; 7(1): 40 - 49. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C.-T. Tai, T.-Y. Liu, P.-C. Lee, Y.-J. Lin, M.-S. Chang, and S.-A. Chen Non-contact mapping to guide radiofrequency ablation of atypical right atrial flutter J. Am. Coll. Cardiol., September 1, 2004; 44(5): 1080 - 1086. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Zhang, G. Younis, R. Hariharan, J. Ho, Y. Yang, J. Ip, R. K. Thakur, J. Seger, M. M. Scheinman, and J. Cheng Lower Loop Reentry as a Mechanism of Clockwise Right Atrial Flutter Circulation, April 6, 2004; 109(13): 1630 - 1635. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Committee Members, C. Blomstrom-Lundqvist, M. M. Scheinman, E. M. Aliot, J. S. Alpert, H. Calkins, A. J. Camm, W. B. Campbell, D. E. Haines, K. H. Kuck, et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias --executive summary: a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) Developed in Collaboration with NASPE-Heart Rhythm Society J. Am. Coll. Cardiol., October 15, 2003; 42(8): 1493 - 1531. [Full Text] [PDF]
|
|
|
|
|
|
C. Blomstrom-Lundqvist, M. M. Scheinman, E. M. Aliot, J. S. Alpert, H. Calkins, A. J. Camm, W. B. Campbell, D. E. Haines, K. H. Kuck, B. B. Lerman, et al. ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias*--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias) Circulation, October 14, 2003; 108(15): 1871 - 1909. [Full Text] [PDF]
|
|
|
|
 |
|
 Committee Members, C. Blomstrom-Lundqvist, M. M Scheinman, E. M Aliot, J. S Alpert, H. Calkins, A.J. Camm, W.B. Campbell, D. E Haines, K. H Kuck, et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary: A Report of the American College of Cardiology/American HeartAssociation Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines(Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias)Developed in collaboration with NASPE-Heart Rhythm Society Eur. Heart J., October 2, 2003; 24(20): 1857 - 1897. [Full Text] [PDF]
|
|
|
|
|
|
A. Bochoeyer, Y. Yang, J. Cheng, R. J. Lee, E. C. Keung, N. F. Marrouche, A. Natale, and M. M. Scheinman Surface Electrocardiographic Characteristics of Right and Left Atrial Flutter Circulation, July 8, 2003; 108(1): 60 - 66. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C.-T. Tai, J.-L. Huang, Y.-K. Lin, M.-H. Hsieh, P.-C. Lee, Y.-A. Ding, M.-S. Chang, and S.-A. Chen Noncontact three-dimensional mapping and ablation of upper loop re-entry originating in the right atrium J. Am. Coll. Cardiol., August 21, 2002; 40(4): 746 - 753. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. L. Waldo Mechanisms of atrial flutter and atrial fibrillation: distinct entities or two sides of a coin? Cardiovasc Res, May 1, 2002; 54(2): 217 - 229. [Full Text] [PDF]
|
|
|
|
|
|
P. Ricard, M. Imianitoff, K. Yaici, J. M. Coutelour, M. Bergonzi, J. P. Rinaldi, and N. Saoudi Atypical atrial flutters Europace, January 1, 2002; 4(3): 229 - 239. [Abstract] [PDF]
|
|