Key result
3D mapping during entrainment shows RAA activation generates positive V1 F waves in typical atrial flutter.
Why the study?
The source of the positive F wave in lead V1 of typical atrial flutter has not been well elucidated.
Does entrainment from the right atrial appendage alter the positive F wave in lead V1 and intra-cardiac conduction patterns during typical atrial flutter?
Observational (n=10)
No
Does entrainment from the right atrial appendage alter the positive F wave in lead V1 and intra-cardiac conduction patterns during typical atrial flutter?
Activation around the right atrial appendage is responsible for generating the positive F wave in lead V1 during typical atrial flutter, as demonstrated by 3D mapping during entrainment.
Supports RAA origin of positive V1 F waves in typical flutter; hypothesis-generating for mapping strategies and requires prospective validation.
Background Typical atrial flutter (AFL) is a macroreentrant tachycardia in which intra-cardiac conduction rotates counterclockwise around the tricuspid annulus. Typical AFL has specific electrocardiographic characteristics of a negative sawtooth-like wave in the inferior lead and a positive F wave in lead V1. Objective This study analyzed the source of the positive F wave in lead V1, which has not been well elucidated. Methods This study included 10 patients who underwent radiofrequency catheter ablation for a typical AFL. Electroanatomical mapping was performed both during typical AFL and entrainment from the right atrial appendage (RAA). The 12-lead electrocardiogram and three-dimensional (3D) electroanatomical maps were analyzed. Results The positive F wave in lead V1 changed during entrainment from the RAA in all the cases. The 3D map during entrainment from the RAA showed an area of antidromic capture around the RAA, which collided with the orthodromic wave in the anterior right atrium. This area of antidromic capture around the RAA was the only difference from the 3D electroanatomical map of tachycardia and is thought to be the cause of the disappearance of the F wave in lead V1 during entrainment. Conclusion The analysis of the differences in the 12-lead ECG and 3D maps between tachycardia and entrainment from the RAA clearly showed that activation around the RAA is responsible for the generation of the positive F wave in lead V1 of typical AFL.
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Yamashita et al. (2023) conducted an observational in Typical atrial flutter (n=10). Entrainment from the right atrial appendage vs. Typical atrial flutter (baseline) was evaluated on Change in positive F wave in lead V1 during entrainment. 3D mapping during entrainment from the right atrial appendage demonstrated that activation around the right atrial appendage generates the positive F wave in lead V1 of typical atrial flutter.
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