Three-dimensional Mapping of the Common Atrial Flutter Circuit in the Right Atrium
| Autor: | Atsusi Takahashi, Pierre Jaïs, Jacques Clémenty, Salah Chouairi, Mélèze Hocini, Stéphane Garrigue, Michel Haïssaguerre, Dipen Shah |
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| Rok vydání: | 1997 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Catheter ablation Superior vena Right atrial Electrocardiography Heart Conduction System Physiology (medical) Internal medicine Humans Medicine Heart Atria cardiovascular diseases Clockwise Monitoring Physiologic medicine.diagnostic_test business.industry Anatomy Middle Aged medicine.disease medicine.anatomical_structure Atrial Flutter Catheter Ablation cardiovascular system Cardiology Right atrium Flutter Female Cardiology and Cardiovascular Medicine business Atrial flutter |
| Zdroj: | Circulation. 96:3904-3912 |
| ISSN: | 1524-4539 0009-7322 |
| DOI: | 10.1161/01.cir.96.11.3904 |
| Popis: | Background The full circuit of common atrial flutter using conventional methods of sequential or multielectrode activation mapping is not completely understood. Methods and Results We performed three-dimensional right atrial endocardial activation mapping during common counterclockwise atrial flutter in 17 patients (16 men, 1 woman; mean age, 53±11 years) by using the Cordis-Biosense EP Navigation system and assessed the distribution of estimated conduction velocities and double and fractionated potentials. ECG flutter wave morphologies were compared with activation patterns. Points (91±29) were sequentially acquired covering 88±11% of the flutter cycle length of 239±22 ms. A wide and variable posterior zone of double and fractionated potentials coincided with blocking and colliding wave fronts and formed the posterior limit of the circuit. A progressively widening septal (sep) wave front ascending from just beyond the coronary sinus ostium, passed cranially as a broad front anterior to the superior vena cava (SVC) in 14 patients, whereas fusion around the SVC formed the superior (sup) limb of the circuit in 3. Bounded anteriorly by the tricuspid valve, the wave front descended down the lateral (lat) aspect of the right atrium before completing the circuit in all cases through the inferior vena cava–tricuspid annulus isthmus. The estimated conduction velocity in the medial isthmus (0.6±0.3 m/s) was lower than in the other limbs of the circuit (sup=1±0.5 m/s, lat=1±0.5 m/s, sep=0.9±0.4 m/s, P =.05). Double and fractionated potentials were constant and more prevalent in the posterior right atrium. ECG flutter wave morphology did not correlate with three-dimensional activation maps. Conclusions Interindividual variations occur in the right atrial circuit of common atrial flutter, with constant activation through the cavotricuspid isthmus. A variable zone of block forms the posterior limit. Fusion around the SVC can occur, and ascending medial septal activation does not follow a consistent pattern. |
| Databáze: | OpenAIRE |
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