Document Detail

Atypical right atrial flutter patterns.
MedLine Citation:
PMID:  11425774     Owner:  NLM     Status:  MEDLINE    
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.
Y Yang; J Cheng; A Bochoeyer; M H Hamdan; R C Kowal; R Page; R J Lee; P R Steiner; L A Saxon; M D Lesh; G W Modin; M M Scheinman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  103     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2001 Jun 
Date Detail:
Created Date:  2001-06-26     Completed Date:  2001-08-09     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3092-8     Citation Subset:  AIM; IM    
Cardiovascular Research Institute and Section of Cardiac Electrophysiology, University of California, San Francisco, USA.
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MeSH Terms
Atrial Flutter / physiopathology*
Cohort Studies
Heart Atria / physiopathology*
Heart Conduction System / physiopathology
Middle Aged
Tachycardia / physiopathology

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