Coronary Sinus Activation and ECG Characteristics of Roof-Dependent Left Atrial Flutter After Pulmonary Vein Isolation.

Autor: Casado Arroyo R; Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Pennsylvania Health System, Philadelphia (R.C.A., S.M., M.K., P.S., F.C.G., T.H., E.S.Z., F.E.M.).; Department of Cardiology, Hôpital Erasme, Université Libre de Bruxelles, Belgium (R.C.A.)., Laţcu DG; Department of Cardiology, Centre Hospitalier Princesse Grace, La Colle, Monaco (D.G.L., B.E., M.E., N.S.)., Maeda S; Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Pennsylvania Health System, Philadelphia (R.C.A., S.M., M.K., P.S., F.C.G., T.H., E.S.Z., F.E.M.)., Kubala M; Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Pennsylvania Health System, Philadelphia (R.C.A., S.M., M.K., P.S., F.C.G., T.H., E.S.Z., F.E.M.)., Santangeli P; Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Pennsylvania Health System, Philadelphia (R.C.A., S.M., M.K., P.S., F.C.G., T.H., E.S.Z., F.E.M.)., Garcia FC; Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Pennsylvania Health System, Philadelphia (R.C.A., S.M., M.K., P.S., F.C.G., T.H., E.S.Z., F.E.M.)., Enache B; Department of Cardiology, Centre Hospitalier Princesse Grace, La Colle, Monaco (D.G.L., B.E., M.E., N.S.)., Eljamili M; Department of Cardiology, Centre Hospitalier Princesse Grace, La Colle, Monaco (D.G.L., B.E., M.E., N.S.)., Hayashi T; Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Pennsylvania Health System, Philadelphia (R.C.A., S.M., M.K., P.S., F.C.G., T.H., E.S.Z., F.E.M.)., Zado ES; Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Pennsylvania Health System, Philadelphia (R.C.A., S.M., M.K., P.S., F.C.G., T.H., E.S.Z., F.E.M.)., Saoudi N; Department of Cardiology, Centre Hospitalier Princesse Grace, La Colle, Monaco (D.G.L., B.E., M.E., N.S.)., Marchlinski FE; Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Pennsylvania Health System, Philadelphia (R.C.A., S.M., M.K., P.S., F.C.G., T.H., E.S.Z., F.E.M.). Francis.Marchlinski@uphs.upenn.edu.
Jazyk: angličtina
Zdroj: Circulation. Arrhythmia and electrophysiology [Circ Arrhythm Electrophysiol] 2018 Jun; Vol. 11 (6), pp. e005948.
DOI: 10.1161/CIRCEP.117.005948
Abstrakt: Background: The electrocardiographic and intracardiac activation features of left atrial roof-dependent macroreentrant flutter have been incompletely characterized.
Methods: Patients post-pulmonary vein (PV) isolation with roof-dependent atrial flutter based on activation and entrainment mapping were included. ECG and coronary sinus activation were compared with mitral annular (MA) flutter.
Results: The roof-dependent left atrial flutter circled the right PVs in 32 of 33 cases. Two forms of roof flutters were identified, posteroanterior, ascendant on posterior wall and descendant on anterior wall (n=24); and anteroposterior, ascendant on the anterior wall and descendent on the posterior wall (n=9). Both forms had positive large amplitude P waves in V 1 through V 2 with decreasing amplitude in V 3 through V 6 . Posteroanterior roof flutters had positive P wave in the inferior and negative P wave in leads I and aVL similar to counterclockwise MA flutter, but coronary sinus activation was simultaneous for roof and proximal to distal for counterclockwise. Anteroposterior roof flutters were similar to clockwise MA flutter with negative P in inferior leads and transition to flat or negative P in V 3 through V 6 . Coronary sinus activation time ≤39 ms identified roof versus MA flutter (sensitivity: 100% and specificity: 97%).
Conclusions: Roof-dependent flutter around right PVs is more common than around left PVs. The ECG pattern for roof-dependent flutter around right PVs is similar to MA flutter with frontal plane axis dictated by septal activation. Roof-dependent flutter can be distinguished from MA flutter by more simultaneous rather than sequential coronary sinus activation.
(© 2018 American Heart Association, Inc.)
Databáze: MEDLINE
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