Document Detail

Coronary sinus pacing initiates counterclockwise atrial flutter while pacing from the low lateral right atrium initiates clockwise atrial flutter. Analysis of episodes of direct initiation of atrial flutter.
MedLine Citation:
PMID:  9817217     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Rapid atrial pacing in sinus rhythm may directly induce atrial flutter without provoking intervening atrial fibrillation, or initiate atrial flutter indirectly, by a conversion from an episode of transient atrial fibrillation provoked by rapid atrial pacing. The present study was performed to examine whether or not the direct induction of clockwise or counterclockwise atrial flutter was pacing-site (right or left atrium) dependent. METHODS AND RESULTS: We analyzed the mode of direct induction of atrial flutter by rapid atrial pacing. In 46 patients with a history of atrial flutter, rapid atrial pacing with 3 to 20 stimuli (cycle length = 500 - 170 ms) was performed in sinus rhythm to induce atrial flutter from 3 atrial sites, including the high right atrium, the low lateral right atrium, and the proximal coronary sinus, while recording multiple intracardiac electrograms of the atria. Direct induction of atrial flutter by rapid atrial pacing was a rare phenomenon and was documented only 22 times in 15 patients: 3, 11, and 8 times during stimulation, respectively, from the high right atrium, low lateral right atrium, and the proximal coronary sinus. Counterclockwise atrial flutter (12 times) was more frequently induced with stimulation from the proximal coronary sinus than from the low lateral right atrium (8 vs 1, P = .0001); clockwise atrial flutter (10 times) was induced exclusively from the low lateral right atrium (P = .0001 for low lateral right atrium vs proximal coronary sinus, P = .011 for low lateral right atrium vs high right atrium). CONCLUSIONS: Direct induction of either counterclockwise or clockwise atrial flutter was definitively pacing-site dependent; low lateral right atrial pacing induced clockwise, while proximal coronary sinus pacing induced counterclockwise atrial flutter. Anatomic correlation between the flutter circuit and the atrial pacing site may play an important role in the inducibility of counterclockwise or clockwise atrial flutter.
F Suzuki; N Toshida; H Nawata; N Yamamoto; K Hirao; N Miyasaka; T Kawara; K Hiejima; T Harada
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of electrocardiology     Volume:  31     ISSN:  0022-0736     ISO Abbreviation:  J Electrocardiol     Publication Date:  1998 Oct 
Date Detail:
Created Date:  1999-01-21     Completed Date:  1999-01-21     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0153605     Medline TA:  J Electrocardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  345-61     Citation Subset:  IM    
First Department of Internal Medicine, Tokyo Medical and Dental University, Japan.
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MeSH Terms
Aged, 80 and over
Atrial Fibrillation / etiology,  physiopathology
Atrial Flutter / etiology*,  physiopathology
Cardiac Pacing, Artificial / adverse effects*
Coronary Vessels*
Heart Atria*
Heart Block / therapy
Heart Rate
Middle Aged
Retrospective Studies
Sick Sinus Syndrome / therapy

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

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