It is generally paroxysmal in nature in a structurally healthy heart. The atrial rate in atrial flutter is approximately 240–360 beats per minute (bpm) with no distinct isoelectric period between the flutter ‘F’ waves. Atrial flutter has been traditionally defined as a macro-reentrant arrhythmia around a macroscopic (more than 2 cm in area) anatomical barrier that is confined within the atria. ![]() Although they are supraventricular in origin, apart from atrial tachycardia, they are not generally included in the nomenclature of supraventricular tachycardia. The more frequent clinically encountered atrial tachyarrhythmias include atrial tachycardia, atrial flutter and atrial fibrillation. 2002 13:662–6.Atrial arrhythmias are significant contributors for cardiac co-morbidity especially for stroke, heart failure and recurrent hospitalisations. Randomized comparison of anatomic and electrogram mapping approaches to ablation of typical atrial flutter. Tada H, Oral H, Ozaydin M, Chugh A, Scharf C, Hassan S, et al. Results from the Loire-Ardèche-Drôme-Isère-Puy-de-Dôme (LADIP) Trial on atrial flutter, a multicentric prospective randomized study comparing amiodarone and radiofrequency ablation after the first episode of symptomatic atrial flutter. 2000 35:1898–904.ĭa Costa A, Thévenin J, Roche F, Romeyer-Bouchard C, Abdellaoui L, Messier M, et al. Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter. Natale A, Newby KH, Pisanó E, Leonelli F, Fanelli R, Potenza D, et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). 2016 67:1575–623.īrugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomstrom-Lundqvist C, et al. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, et al. Springer Science+Business Media, LLC, part of Springer Nature. The bidirectional CTI block can be assessed quickly and easily using only the ablation and CS catheters for differential pacing.Ītrial flutter Catheter ablation Cavo-tricuspid isthmus block. During the next 15.9 ± 0.7 months, two patients were lost to follow-up, and among the 62 other patients, one (1.7%) had flutter recurrence. Atrial flutter was rendered not inducible in all patients, and no procedural complications were encountered. Clinical efficacy was defined as freedom from recurrent AFl during follow-up.įollowing 12.2 ± 3.7 min of RF delivery across the CTI, intervals were Stim CS-Abl 1 = 181.2 ± 22.7 ms and Stim ABL1-CS = 181.0 ± 23.6 ms, and Stim CS-Abl 2 = 152.2 ± 26.5 ms and Stim ABL2-CS = 151.2 ± 22.7 (P < 0.001). ![]() The criteria for the bidirectional block were Stim CS-Abl 1 > Stim CS-Abl 2, and Stim ABL1-CS > Stim ABL2-CS. Pacing with the ablation catheter also was performed at these 2 sites, and the stimulus-to-CS electrogram intervals (Stim ABL1-CS and Stim ABL2-CS) were measured. The stimulus-to-ablation catheter atrial electrogram intervals were measured at these sites (Stim CS-Abl 1 and Stim CS-Abl 2, respectively). Pacing was performed in the CS with an ablation catheter positioned immediately lateral to the CTI ablation line, and then 1-2 cm more laterally. The acute endpoints were non-inducibility of the AFl, and verification of the bidirectional CTI block by our methodology. Sixty-two patients underwent radiofrequency (RF) ablation of CTI-dependent AFl. The purpose of this study is to describe a modified differential pacing technique to evaluate the CTI block. Differential pacing has been used to evaluate the CTI block. Bidirectional block of the cavo-tricuspid isthmus (CTI) is an established endpoint of CTI-dependent atrial flutter (AFl) ablation.
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