What is the clinical evidence from this study?

Study design: Observational. Population: Atrial flutter (n=11). Intervention: Heart transplantation vs. Nontransplanted heart. Primary outcome: Difference between the first postpacing interval (FPPI) and the flutter cycle length (FCL).

What does this research mean for the field?

Atrial flutter in transplanted hearts is driven by macroreentry around the tricuspid annulus rather than the surgical atrial anastomotic incision. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To identify the electrophysiological mechanisms and anatomical locations of atrial flutter circuits in cardiac transplant recipients using transient entrainment pacing from distant sites.

September 5, 2026Journal of the American College of CardiologyOpen Access

Mechanism and Location of Atrial Flutter in Transplanted Hearts: Observations During Transient Entrainment From Distant Sites

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Key result

Post-transplant atrial flutter is likely driven by tricuspid ring macroreentry rather than the crista terminalis.

n=11

Why the study?

Although F wave morphology in atrial flutter is similar in nontransplanted and transplanted hearts, the surgical incision for atrial anastomosis may create a distinct electrophysiologic substrate.

What is the location and mechanism of typical atrial flutter in transplanted hearts compared to nontransplanted hearts?

Population

Five patients with a transplanted heart and six patients with a nontransplanted heart

Comparison

Transplanted heart vs nontransplanted heart during entrainment

Design

Electrophysiological study

Authors

ÁAÁngel ArenalElectrophysiology JAJesús AlmendralElectrophysiology RMRoberto MuñózCatholics for Choice

Discussion

Member takes

Implication

May inform EPS-guided ablation in post-transplant atrial flutter; leaves open generalizability and outcome impact.

Key Points

To identify the electrophysiological mechanisms and anatomical locations of atrial flutter circuits in cardiac transplant recipients using transient entrainment pacing from distant sites.
Conducted electrophysiological evaluation and transient entrainment pacing from distant atrial sites in heart transplant recipients experiencing atrial flutter.
Demonstrated that transient entrainment from distant pacing sites successfully localizes the reentrant circuits responsible for atrial flutter.
Characterized the specific anatomical pathways and mechanistic properties sustaining atrial flutter in the transplanted heart.

Study Design

Type

Observational (n=11)

Structured PICO

What is the location and mechanism of typical atrial flutter in transplanted hearts compared to nontransplanted hearts?

Population

11 patients with typical atrial flutter (5 with transplanted hearts and 6 with nontransplanted hearts) undergoing entrainment mapping.

Exposure

Entrainment mapping from the lateral wall of the right atrium and interatrial septum

Comparator

Nontransplanted hearts (for the transplant group)

Outcome

Difference between the first postpacing interval (FPPI) and the flutter cycle length (FCL)surrogate

Atrial flutter in transplanted hearts is likely driven by macroreentry around the tricuspid ring, whereas in nontransplanted hearts, other structures like the crista terminalis may be involved.

Cite This Study

Arenal et al. (1997) conducted an observational in Atrial flutter (n=11). Heart transplantation vs. Nontransplanted heart was evaluated on Difference between the first postpacing interval (FPPI) and the flutter cycle length (FCL). Atrial flutter in transplanted hearts is likely driven by macroreentry around the tricuspid ring, whereas in nontransplanted hearts, the crista terminalis may be involved.

synapsesocial.com/papers/6a9b8a16b297cd8b5cac0bc5 https://doi.org/10.1016/s0735-1097(97)00186-1

Topics

Heart transplantation

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Mechanism and Location of Atrial Flutter in Transplanted Hearts: Observations During Transient Entrainment From Distant Sites

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Topics

Mechanism and Location of Atrial Flutter in Transplanted Hearts: Observations During Transient Entrainment From Distant Sites

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

Topics

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