Radiofrequency ablation creating a line of block between the septum primum and the mitral annulus cured left septal atrial flutter in 100% of patients compared to 40% with a pulmonary vein line.
Observational (n=11)
Does radiofrequency ablation prevent recurrence in patients with left septal atrial flutter?
Radiofrequency ablation creating a line of block between the septum primum and the mitral annulus is effective for curing left septal atrial flutter.
Absolute Event Rate: 100% vs 40%
BACKGROUND: We describe the clinical and electrophysiological characteristics of a novel macroreentrant form of left atrial flutter circuit. METHODS AND RESULTS: A total of 11 patients were included in the study. The mean tachycardia cycle length was 278+/-41 ms. Nine of the 11 patients were treated with antiarrhythmic drugs at the time of the study for concomitant atrial fibrillation. With the use of entrainment pacing and either the CARTO Biosense mapping system (9 patients) or conventional mapping (2 patients), the flutter circuit was found to rotate around the left septum primum with a critical isthmus located between the pulmonary veins posteriorly and/or mitral annulus anteriorly and the septum primum. In 5 patients, radiofrequency ablation was performed from the septum primum to the right inferior pulmonary vein (group 1), and in 6 patients, a lesion was made from the septum primum to the mitral annulus (group 2). After a follow-up of 13+/-6 months, 2 patients in group 1 and all patients in group 2 remained in sinus rhythm without recurrence. CONCLUSIONS: Slowing of electric conduction in the left atrial septum due to antiarrhythmic drugs and/or atrial myopathy seems to promote left septal atrial flutter. Radiofrequency ablation of this arrhythmia is usually effective and safe. A line of block between the septum primum and the mitral annulus proved to be effective for cure of tachycardia.
Marrouche et al. (2004) conducted an observational in Left septal atrial flutter (n=11). Radiofrequency ablation from septum primum to mitral annulus vs. Radiofrequency ablation from septum primum to right inferior pulmonary vein was evaluated on Maintenance of sinus rhythm without recurrence. Radiofrequency ablation creating a line of block between the septum primum and the mitral annulus cured left septal atrial flutter in 100% of patients compared to 40% with a pulmonary vein line.