Document Detail

Various routes of septal propagation in common atrial flutter.
MedLine Citation:
PMID:  14618051     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Although in the treatment of common atrial flutter, the isthmus between the tricuspid valve annulus and the eustachian ridge is often chosen as the site for conduction block by radiofrequency ablation, the precise path of the flutter circuit remains unknown. We therefore investigated the propagation of the atrial flutter wave front around the coronary sinus ostium and how its path is altered by application of radiofrequency current. METHODS AND RESULTS: To assess activation pattern, activation in the region surrounding the coronary sinus ostium was mapped using a deflectable decapolar catheter under basal conditions and while applying radiofrequency current to the septal isthmus, between the tricuspid valve annulus and the eustachian ridge. In five of eleven patients studied, the eustachian ridge side, below the coronary sinus ostium, was activated earlier, and the flutter wave exited from either the tricuspid valve annulus side or the eustachian ridge side, above the coronary sinus ostium. In four patients, a partial line of block created by applying radiofrequency current between the tricuspid valve annulus and the coronary sinus ostium or between the coronary sinus ostium and the eustachian ridge led to a shift in the direction of propagation of the flutter wave front from anterior to posterior or from posterior to anterior of the coronary sinus ostium, and prolongation of the cycle length. CONCLUSION: Application of radiofrequency current to the septal isthmus, between the tricuspid valve annulus and the eustachian ridge, can shift both the anterior and posterior propagation of flutter around the coronary sinus ostium.
Taro Date; Kunihiko Abe; Hidekazu Miyazaki; Teiichi Yamane; Kenichi Sugimoto; Junichi Mogi; Youichi Honda; Kenji Noma; Shinichiro Ishikawa; Seibu Mochizuki
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing     Volume:  9     ISSN:  1383-875X     ISO Abbreviation:  J Interv Card Electrophysiol     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2003-11-17     Completed Date:  2004-04-23     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9708966     Medline TA:  J Interv Card Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  317-26     Citation Subset:  IM    
Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan.
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MeSH Terms
Atrial Flutter / physiopathology*
Catheter Ablation*
Electrophysiologic Techniques, Cardiac*
Heart Conduction System / physiopathology*
Heart Diseases / physiopathology
Middle Aged
Tricuspid Valve / physiopathology

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