Key result
Noncontact electroanatomic mapping demonstrated that the right atrial posterior wall participates in the reentrant circuit of typical atrial flutter in 80% (12 of 15) of patients.
Observational (n=15)
Noncontact electroanatomic mapping demonstrates that the right atrial posterior wall actively participates in the reentrant circuit of typical atrial flutter in a subset of patients.
May indicate posterior wall role in some typical flutter circuits; leaves open whether targeted ablation improves outcomes.
BACKGROUND: Reentry utilizing cavotricuspid isthmus (CTI) is accepted as the mechanism underlying typical atrial flutter (AFLT). However, it is unclear how the right atrial (RA) posterior wall (PW) participates in AFLT circuit. We sought to investigate this by using noncontact electroanatomic mapping. METHODS: Fifteen patients (pts) undergoing ablation for typical AFLT participated. Multipolar catheters were deployed in RA and coronary sinus. RA shell was created during AFLT. Entrainment was performed to confirm CTI dependence and assess participation of various RA regions (septum-Sep, PW, lateral wall-LW). Data were analyzed for (1) RA activation patterns and (2) conduction time (CT) through various RA regions. RESULTS: Mean pt age was 70 ± 13 years (all males; CCW = 10; CW = 5). Mean AFLT cycle length was 255 ± 15 ms. Single activation wave front traversing sequentially CTI, Sep, and LW was seen in all pts and in 12 (80%; 9 CCW, 3 CW) this also traversed PW. Entrainment confirmed PW participation in 7 of these. Mean CT (in ms) through various RA regions was as follows: CTI = 69 ± 27, Sep = 50 ± 39, PW = 65 ± 35, and LW = 76 ± 35; P = NS. CONCLUSION: These observations offer new insights regarding the participation of PW in the reentrant circuit of typical AFLT in some patients.
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Dixit et al. (2010) conducted an observational in Typical atrial flutter (n=15). Noncontact electroanatomic mapping was evaluated on Right atrial activation patterns and conduction time through various RA regions (p=NS). Noncontact electroanatomic mapping demonstrated that the right atrial posterior wall participates in the reentrant circuit of typical atrial flutter in 80% (12 of 15) of patients.
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