Electrophysiological characteristics and radiofrequency ablation of right atrial flutter

This study aimed to elaborate the electrophysiology characteristics and radiofrequency ablation (RFA) results of atrial flutter (AFL) which  has  not  been  established in  Indonesia. Three multipolar  catheters  were  inserted  percutaneously  and  positioned  into  coronary sinus  (CS),  His  bundle  area  and  around  tricuspid  annulus.  Eight  mm  ablation  catheter was  used  to  make  linear  ablation  at  CTI  of typical and reverse typical AFL. Bidirectional block was confirmed by conduction time prolongation of more than 90 msec from low lateral to CS ostium and vice versa, and/or by means of differential pacing. ThirtyAFL from 27 patients comprised of 19typical AFL, 5 reverse typical AFL and 6 atypical AFL enrolled the study. Mean tachycardia cycle length (TCL) were 261.8± 42.84,226.5 ± 41.23, and 195.4± 9.19msec, respectively (p = 0.016). CTI conductiontime occupied up to 60% of TCL with mean conduction time of 153.0±  67.37msec.  CS  activation  distributed  to  three  categories  which comprised  of  proximal  to  distal,  distal  to  proximal  and  fusion activation. Only nine of 27 patients had no structural heartdisease. RFA of symptomatic typical and reverse typical AFL demonstrated 96%  success  and 4.5 %  recurrence  rate  during  13  ±  8  months  follow  up.  Typical  AFL  is  the  predominant  type  of  AFL  in  our population.  The  majority  of  AFL  cases  suffered  from  structuralheart  disease.  RFA  was  highly  effective  to  cure  typical  and  reverse typical AFL. (Med J Indones 2007; 16:151-8)