Key result
Radiofrequency ablation applied to the septal cavotricuspid isthmus successfully terminated intra-isthmus reentry tachycardia and rendered it non-inducible in all three patients.
Why the study?
What are the electrogram and surface ECG characteristics of intra-isthmus reentry?
Case Report (n=3)
No
What are the electrogram and surface ECG characteristics of intra-isthmus reentry?
Intra-isthmus reentry is a localized tachycardia circuit within the septal CTI/CSos region that can present with either typical or atypical atrial flutter ECG patterns.
Supports targeted septal CTI ablation for intra-isthmus reentry; leaves open prospective validation of ECG/EGM criteria.
Background: Intra-isthmus reentry (IIR) denotes a reentry circuit within the cavotricuspid isthmus (CTI). The purpose of this study was to define the electrogram and surface ECG characteristics of IIR. Methods and Results: Three patients underwent electrophysiologic examination and were found to have IIR; the IIR in 1 patient was found during a redo procedure. Detailed electrogram mapping of the CTI and electroanatomic mapping (EAM) were performed in all 3 patients. Entrainment mapping in all patients during tachycardia proved reentry and showed that the anteroinferior CTI was outside the circuit and that the septal CTI was within the circuit. During tachycardia, fractionated or double potentials were recorded at either the septal CTI and/or the region of the coronary sinus ostium (CSos). The surface ECG showed a typical counterclockwise (CCW) pattern in 2 patients and an atypical pattern in 1 patient, and EAM showed a CCW pattern in 2 patients and a focal pattern in 1 patient. The one patient with atypical ECG pattern in spite of the CCW activation pattern showed a low voltage area at the inferolateral tricuspid annulus. Conclusions: IIR presents as a tachycardia circuit confined to the septal CTI/CSos region, and surface ECG characteristics show either typical CTI-dependent AFL or atypical AFL patterns.
No takes yet. Share an insight, caveat, or question.
Kofune et al. (2015) conducted a case report in Intra-isthmus reentry (IIR) / Atrial flutter (n=3). Radiofrequency ablation of the septal cavotricuspid isthmus was evaluated on Termination of tachycardia and non-inducibility. Radiofrequency ablation applied to the septal cavotricuspid isthmus successfully terminated intra-isthmus reentry tachycardia and rendered it non-inducible in all three patients.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: