Conduction Properties of the Crista Terminalis and Its Influence on the Right Atrial Activation Sequence in Patients with Typical Atrial Flutter

2002 ◽  
Vol 25 (2) ◽  
pp. 132-141 ◽  
Author(s):  
HIROSHIGE YAMABE ◽  
IKUO MISUMI ◽  
HIRONOBU FUKUSHIMA ◽  
KAZUHIRO UENO ◽  
YOSHIHIRO KIMURA ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Right Atrial ◽  
Crista Terminalis ◽  
Typical Atrial Flutter ◽  
Atrial Activation ◽  
The Right ◽  
Conduction Properties ◽  
Activation Sequence

The impact of age on the right atrial substrate properties in patients with typical atrial flutter

Heart Rhythm ◽  
2005 ◽  
Vol 2 (5) ◽  
pp. S190
Author(s):  
Tu-Ying Liu ◽  
Yenn-Jiang Lin ◽  
Mary Gertrude Y. Ong ◽  
Shih-Lin Chang ◽  
Ching-Tai Tai ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Right Atrial ◽  
Typical Atrial Flutter ◽  
Substrate Properties ◽  
The Right ◽  
The Impact

Abstract 19335: Not Your Typical Atrial Flutter

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Matthew D Olson ◽  
Selcuk Adabag
Keyword(s):  
Atrial Flutter ◽  
Right Atrial ◽  
Vein Thrombosis ◽  
Typical Atrial Flutter ◽  
Determining Factors ◽  
Surgical Thrombectomy ◽  
Clinical Dilemma ◽  
The Right ◽  
In Transit ◽  
Deep Vein

Case: Mr M. presented to the emergency room with two months of progressive shortness of breath and was found to be in atrial flutter with 2:1 conduction at a rate of 140 bpm. His medical history was significant for tobacco use, etoh abuse, and hypertension. Key objective findings included tachycardia, hypoxia an elevated JVP, bibasilar crackles, a summation gallop, and lower extremity edema. His work up included an echocardiogram that illustrated a globally depressed EF (15-20%) and a large “worm like” mass that was free floating and extended into the RV. Management: A heparin drip was already infusing as the initial plan included cardioversion. Since the patient remained hemodynamically stable and there was no evidence of concurrent deep vein thrombosis, a TEE was performed to fully evaluate the mass and to assess the intra-atrial septum for right to left shunting. The TEE with 3D renderings demonstrated a mobile 0.8 x 10 cm mass most consistent with a thrombus that intermittently prolapses through the tricuspid valve into the RV. CT surgery was consulted and discussed the options of thrombolysis vs surgical thrombectomy. Due to the size and apparent dense organization of the thrombus, surgical thrombectomy was performed. When the right atrium was opened after initiation of bypass, there was no visible clot. The main PA was explored and without evidence of the thrombus. As bypass flow decelerated, the clot proceeded into the RA from the IVC cannula. The attached picture illustrates the thrombus removed from the RA and associated echo images. Discussion: Right atrial or ventricular thrombi in transit in hypoxic patients create a challenging clinical dilemma, as distal embolization may be fatal. In this case we chose to surgically remove the thrombus instead of the more commonly employed thrombolytic therapy. The determining factors included clot organization, relative patient stability, and surgical candidacy.

scholarly journals Right Atrial Fibroelastoma Presenting as Typical Atrial Flutter: Rare Disease in Unusual Location

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Ahmad Abuarqoub ◽  
Ghada Elshimy ◽  
Muhammed Shittu ◽  
Aiman Hamdan ◽  
Fayez Shamoon
Keyword(s):  
Inferior Vena Cava ◽  
Atrial Flutter ◽  
Right Atrium ◽  
Inferior Vena ◽  
Vena Cava ◽  
Right Atrial ◽  
Unusual Location ◽  
Typical Atrial Flutter ◽  
The Right ◽  
Right Atria

Typical atrial flutter as initial presentation of papillary fibroelastoma involving the cavotricuspid isthmus is not described before in literature. To our knowledge only 14 cases have been reported in literature involving the right atrium. Very unusual location is at the junction between inferior vena cava (IVC) and right atria as only 1 case has been reported.

Characterization of Low Right Atrial Isthmus as the Slow Conduction Zone and Pharmacological Target in Typical Atrial Flutter

Circulation ◽  
1997 ◽  
Vol 96 (8) ◽  
pp. 2601-2611 ◽  
Author(s):  
Ching-Tai Tai ◽  
Shih-Ann Chen ◽  
Chern-En Chiang ◽  
Shih-Huang Lee ◽  
Kwo-Chang Ueng ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Right Atrial ◽  
Slow Conduction ◽  
Typical Atrial Flutter ◽  
Pharmacological Target ◽  
Conduction Zone

Role of sinoatrial ring bundle in internodal conduction

1976 ◽  
Vol 231 (2) ◽  
pp. 319-325 ◽  
Author(s):  
M Hiraoka ◽  
T Sano
Keyword(s):  
Sinus Node ◽  
The Other ◽  
Wave Fronts ◽  
Av Node ◽  
Crista Terminalis ◽  
Main Route ◽  
Endocardial Surface ◽  
The Right ◽  
Activation Sequence

The role of the sinoatrial ring bundle (SARB) in internodal conduction was examined by the microelectrode technique in excised rabbit hearts. The spread of the sinus impluse to the surrounding tissues was shown to proceed anteriorly toward the right branch of the crista terminalis significantly faster than toward the other direction. Thus the right SARB and the right branch of the crista terminalis close to the sinus node were the earliest areas excited by the sinus impulse in the areas surrounding the sinus node. It was further shown that the activation sequence does not initiate from the right SARB to the right branch of the crista terminalis via the junction of these two structures. Cutting the SARB did not produce any delay in conduction from the sinus node to the atrioventricular (AV) node. The conduction velocity measured at the endocardial surface by two microelectrodes has proved that conduction in the crista terminalis was significantly faster than in the SARB. The upstroke of the action potential from the crista terminalis was also steeper than that from the SARB. These results suggest that the SARB is not the main route for impulse propagation from the sinus node to the AV node; the fastest internodal conduction therefore takes place with wide wave fronts, along the crista terminalis.

Relation of canine atrial activation sequence to anatomic landmarks

1982 ◽  
Vol 242 (3) ◽  
pp. H421-H428 ◽  
Author(s):  
H. Hayashi ◽  
R. L. Lux ◽  
R. F. Wyatt ◽  
M. J. Burgess ◽  
J. A. Abildskov
Keyword(s):  
Fiber Direction ◽  
Entry And Exit ◽  
Activation Time ◽  
Anatomic Landmarks ◽  
Crista Terminalis ◽  
Bipolar Electrodes ◽  
First Derivative ◽  
Bachmann’S Bundle ◽  
Atrial Activation ◽  
Activation Sequence

Activation sequence in the atria was investigated in 35 dogs. The atria were studied as four regions, and activation sequence in one region was determined in each experiment. In each region 60 electrograms were recorded simultaneously from bipolar electrodes. The maximal first derivative of the electrograms was taken as activation time. Dried atrial specimens, which permitted identification of pectinate muscles, crista terminalis, and the axis of fiber direction, were prepared. Nonuniform activation was demonstrated with more rapid conduction over the long axis of fiber direction and in Bachmann's bundle, crista terminalis, and pectinate muscles. These regions of rapid conduction were the same during sinus rhythm and ectopic and retrograde activation. Findings confirm the presence of paths with relatively rapid conduction in the atria and demonstrate that these are related to gross anatomic features. Findings also demonstrate that the paths are accessible to activation from multiple sites rather than insulated conduction paths with limited sites for entry and exit of activation.

scholarly journals Feasibility and efficacy using the KODEX-EPD imaging system in right atrial flutter ablation: a single center experience

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
V Schillaci ◽  
G Stabile ◽  
G Shopova ◽  
A Arestia ◽  
A Agresta ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Imaging System ◽  
Conduction Block ◽  
Right Atrial ◽  
Atrial Pacing ◽  
Funding Sources ◽  
Single Center Experience ◽  
Typical Atrial Flutter ◽  
Procedural Time

Abstract Background Isthmus-dependent right atrial flutter is the most frequently encountered atrial flutter in clinical practice (80–90% of atrial flutters). Purpose The aim of our study was to assess as first experience the feasibility and safety of radiofrequency catheter ablation (RFCA) of cavo-tricuspid isthmus (CTI) guided by KODEX-EPD imaging system in patients presenting with typical atrial flutter (AFL). Methods 16 consecutive patients (mean age 68,46±7,8 years, 80% males) with diagnosis of AFL underwent RFCA guided by KODEX-EPD imaging system. In 15 patients the analysis performed during tachycardia showed a counter-clockwise activation. In 1 patient no tachycardia could be induced and the ablation was performed in sinus rhythm with fixed pacing from the coronary sinus. The KODEX-EPD imaging system was also used to guide ablation and to confirm persistent bidirectional block after ablation. Results Mean procedural time was 37,6±8,2 min, mean radiofrequency ablation time was 7,8±3,4 min, and mean fluoroscopy time was 2,1±1,2 min. All procedures were acutely successful with interruption of AFL during RFCA along the inferior CTI in 15 patients and achievement of the bidirectional conduction block in 16 patients proven by atrial pacing medial and lateral to the ablation line. There were no major procedural and 30-day complications. Over a mean follow-up of 18 months, we observed no recurrence of arrhythmia and no complications. Conclusions Our study shows that RFCA for AFL using the KODEX-EPD imaging system is feasible, safe, and effective. FUNDunding Acknowledgement Type of funding sources: None.

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