Document Detail


Characteristics of cavotricuspid isthmus-dependent atrial flutter after left atrial ablation of atrial fibrillation.
MedLine Citation:
PMID:  16461832     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Patients who have previously undergone ablation of atrial fibrillation may experience cavotricuspid isthmus (CTI)-dependent atrial flutter during follow-up. The effects of left atrial (LA) ablation on the characteristics of CTI-dependent flutter have not been described. METHODS AND RESULTS: Fifteen patients underwent ablation of CTI-dependent flutter late after LA ablation of AF. The ECG, biatrial activation patterns, and LA voltage maps during flutter were analyzed. Thirty age- and gender-matched patients who underwent ablation of CTI-dependent flutter without prior LA ablation served as control subjects. Among the patients with prior LA ablation, mapping revealed counterclockwise activation around the tricuspid annulus in 12 of 15 patients (80%) and clockwise activation in 3 of 15 patients (20%). The flutter waves in the inferior leads were upright in 9 of the 15 patients (60%) with prior LA ablation and in none of the control subjects (P<0.001). The upright flutter waves in the inferior leads in patients with counterclockwise flutter corresponded to craniocaudal activation of the right atrial free wall. LA activation contributed little to the genesis of the flutter waves in these patients because of a significant reduction in bipolar LA voltage (0.44+/-0.20 versus 1.54+/-0.19 mV in patients with biphasic/negative flutter waves; P<0.001). CONCLUSIONS: CTI-dependent flutter that occurs after LA ablation of atrial fibrillation often has atypical ECG characteristics because of altered LA activation. In patients presenting with atrial flutter after LA ablation, entrainment mapping should be performed at the CTI even if the ECG is uncharacteristic of CTI-dependent flutter.
Authors:
Aman Chugh; Rakesh Latchamsetty; Hakan Oral; Darryl Elmouchi; David Tschopp; Scott Reich; Petar Igic; Tammy Lemerand; Eric Good; Frank Bogun; Frank Pelosi; Fred Morady
Publication Detail:
Type:  Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  Circulation     Volume:  113     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-02-07     Completed Date:  2006-03-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  609-15     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, University of Michigan Hospitals, Ann Arbor, MI, USA. achugh@umich.edu
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MeSH Terms
Descriptor/Qualifier:
Atrial Fibrillation / complications,  therapy*
Atrial Flutter / etiology,  physiopathology*
Body Surface Potential Mapping
Catheter Ablation / adverse effects*
Electrocardiography
Female
Heart Atria / physiopathology
Heart Conduction System / physiopathology
Humans
Male
Middle Aged
Tricuspid Valve / physiopathology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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