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(Circulation. 1999;99:3206-3208.)
© 1999 American Heart Association, Inc.

Images in Cardiovascular Medicine

Spot Welding the Gap in Atrial Flutter Ablation

Paul A. Friedman, MD; Marshall S. Stanton, MD

From the Mayo Clinic, Rochester, Minn.

Correspondence to Paul A. Friedman, MD, Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905.

View larger version (58K): [in this window] [in a new window]   Figure 1. A, Left anterior oblique view of right atrium (view is from right ventricle looking into right atrium with tricuspid valve removed). Yellow curved arrow demonstrates electrical activation around tricuspid valve annulus during atrial flutter. Isthmus catheter has multiple electrode pairs that record electrical activation and spans isthmus of tissue between inferior vena cava and tricuspid valve annulus. Its poles I-1,2 (I is for isthmus catheter, and 1 and 2 are most distal electrodes) are at coronary sinus ostium, and poles I-19,20 are low lateral right atrium. Intervening poles are numbered sequentially but not labeled. MEA indicates multiple electrode array, part of Ensite 3000 noncontact mapping system, which reconstructs endocardial electrical activation in a 3-dimensional model. Dashed line depicts site of linear ablation for atrial flutter. B, Right anterior oblique view of right atrium. Note that completion of ablation line (dashed line from tricuspid valve to inferior vena cava) will interrupt flutter circuit. Depicted in white is tricuspid valve (which was cut away in Figure 1A). C, Electrograms from intracardiac catheters. Three left complexes show atrial flutter. Note that activation proceeds from poles I-19,20, positioned at low lateral right atrial wall, toward I-1,2, positioned near coronary sinus. This is typical counterclockwise atrial flutter. After third beat during delivery of radiofrequency energy (not shown), atrial flutter terminates and sinus rhythm ensues. Note change in morphology of P waves in lead II. afl and nsr indicate atrial flutter and normal sinus rhythm, respectively.

View larger version (50K): [in this window] [in a new window]   Figure 2. A, After ablation line is . . . [Full Text of this Article]

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