scholarly journals Right Atrial Collision Time (RACT): a novel marker of propensity for typical atrial flutter

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Crinion ◽  
M Al-Turki ◽  
N Al Hammad ◽  
V Neira ◽  
A De Leon ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Right Atrial ◽  
Collision Time ◽  
Clinical Value ◽  
Chamber View ◽  
Echocardiographic Measurement ◽  
Coronary Sinus Ostium ◽  
Typical Atrial Flutter ◽  
Significant Difference ◽  
Anterolateral Wall

Abstract Background The risk of typical atrial flutter (AFL) is increased by factors that increase right atrial (RA) size or cause scarring to reduce conduction velocity. These characteristics ensure the macro re-entrant wave front does not meet its refractory tail. The time taken to traverse the circuit would take account of both of these characteristics (being equal to distance divided by velocity), and may provide a superior marker of propensity to develop AFL. Purpose To investigate right atrial collision time (RACT) as a marker of typical AFL. Methods This single centre, prospective study recruited consecutive typical AFL ablation cases that were in sinus rhythm. Controls were consecutive cases other than atrial fibrillation and >50 years of age. Exclusion criteria for both groups were a prior ablation in the RA and class I and III antiarrhythmics. While pacing the coronary sinus ostium at 600 ms, a local activation time map was created to locate the latest collision point on the anterolateral wall, excluding the RA appendage (Figure 1). This RACT approximates half a revolution. Results The AFL group's (n=34) mean RACT was 132.5±15.06 vs 98.7±12.23ms in the controls (n=40) (p<0.01). No significant difference was observed for age (mean 65.6 vs 62.6 (p=0.18)), male (68.8% vs 60% (p=0.59)), body surface area (mean 2.1 vs 2.03 m2 (p=0.24)). The RACT also proved to be a superior marker than the echocardiographic measurement of right atrial area in an apical four chamber view (mean 17.8 vs 16.3 cm2 (p=0.21).A ROC curve indicated an AUC of 0.97 (95% CI: 0.93–1.0, p<0.01). A RACT cut-off of 120 ms had a specificity of 99% and a sensitivity of 75%. Conclusion RACT is a novel and promising marker of propensity for typical AFL. The ability to predict AFL would be of significant clinical value given the risk of stroke and frequent need for ablation. Funding Acknowledgement Type of funding source: None

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

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.

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

scholarly journals The use of half normal saline during catheter ablation of typical atrial flutter has no impact on the time to achieve bidirectional block

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N.J.H Alhammad ◽  
D.R Redfearn ◽  
A.E Enriquez ◽  
S.C Chacko ◽  
K.H Hong ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Atrial Flutter ◽  
Normal Saline ◽  
Conduction Block ◽  
Ionic Concentration ◽  
Typical Atrial Flutter ◽  
Population Reduction ◽  
Significant Difference ◽  
Power Setting ◽  
The Mean

Abstract Background Achieving bidirectional block (BB) is generally considered to be the endpoint in the ablation of typical atrial flutter (AFL), however acute reconnection is common. Recent data suggest that deeper ablation lesions may be created by decreasing the irrigant ionic concentration using half normal saline (HNS) delivered through an open irrigated ablation catheter compared with normal saline (NS). We sought to assess whether the use of HNS was associated with a more rapid achievement of BB and less reconnections compared with NS. Methods Patients were randomly allocated to catheter ablation with either NS or HNS using a 4-mm irrigated catheter at a power setting of 30 W. Ablation approach employing either a maximum voltage guided (MVG) or empiric cavo-tricuspid isthmus (CTI) line was performed aiming for BB that was confirmed by double potentials separated by an isoelectric line measuring ≥110 ms and evidence of conduction block using differential pacing. Study was powered to an endpoint of acute reconnection within 30 mins. Results A total of 60 patients underwent catheter ablation for typical AFL with either HNS (n=30) or NS (n=30). There were no significant differences between the two groups in terms of patient age (68±7 yrs HNS vs. 68±10 yrs NS) and BMI (31±7 HNS vs 31±5 NS). BB was achieved in all patients. The MVG approach was employed in 28/60 patients. Acute reconnection was observed in 11 patients (18%); 4 in HNS vs 7 in NS group (ns). The mean RF time to achieve BB was 386±262 seconds in HNS vs 456±270 seconds in NS (p=0.21). The approach to CTI ablation showed a significant difference in time to BB: Time to block in MVG cases was 264±143 seconds vs 567±273 in empiric CTI line cases. Figure 1 demonstrates the time to block in both approaches with the choice of irrigant not appearing to impact the time to BB. There were 4 steam pops in the HNS arm and 0 steam pops observed in the NS arm. There were no significant complications in either arm. Conclusion Irrigation with HNS resulted in no statistically significant reduction in duration of RF time or improvement in acute outcomes over NS in the atrial flutter population. Reduction in duration of RF time was driven by MVG approach. However, acute reconnections were higher in NS group, all 4 steam pops occurred in HNS arm. Figure 1 Funding Acknowledgement Type of funding source: None

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 Comparison of clockwise and counterclockwise right atrial flutter using high-resolution mapping

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Yvorel ◽  
A Da Costa ◽  
C Lerebours ◽  
J B Guichard ◽  
G Viallon ◽  
...  
Keyword(s):  
High Resolution ◽  
Atrial Flutter ◽  
Left Ventricular ◽  
Right Atrial ◽  
Left Ventricular Ejection ◽  
Lateral Side ◽  
Ventricular Ejection Fraction ◽  
Ridge Line ◽  
Mapping System ◽  
Significant Difference

Abstract Background To the best of our knowledge, few studies have been performed that explore the electrophysiological differences between clockwise (CW) and counterclockwise (CCW) right atrial (RA) cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) using the high-resolution Rhythmia mapping system. Objectives. Accordingly, our prospective cohort study, sought to compare CW and CCW CTI-dependent AFL in preselected pure right AFL patients (pts) using the ultra-high-definition (ultra-HD) Rhythmia mapping system. The study also aimed to mathematically develop a cartography model based on automatic velocity RA measurements to identify electrophysiological AFL specificities. Methods and results Between October 2019 and July 2020, 33 patients were recruited. The mean age was 71±13 years old. No difference was found concerning clinical variables between CCW AFL and CW AFL or regarding left ventricular ejection fraction (LVEF) (55.5±10 vs. 56.6±12; p=0.76). The AFL cycle length was very similar (248±20 vs. 252±28 ms; p=0.6). The sinus venosus (SV) block line was present in 32/33 of cases (97%) and no significant difference was found between CCW and CW CTI AFL (100% vs. 91%; p=0.7). No line was localized in the region of the crista terminalis (CT). A superior gap was present in the posterior line in 14/31 (45.2%) but this was similarly present in CCW AFL, when compared to CW AFL (10/22 [45.5%] vs. (4/10 [40%]); p=0.9). When present, the extension of the posterior line of block was observed in 18/31 pts (58%) without significant differences between CCW and CW CI AFL (12/22 [54.5%] vs. (6/10 [60%]) (p=.9) The Eustachian ridge line of block was similarly present in both groups (82% [18/22] vs. 45.5% [5/11]; p=0.2). The absence of the Eustachian ridge line of block led to significantly slowed velocity in this area (28±10cm/s; n=8),and the velocities were similarly altered between both groups (26±10 [4/22] vs. 29.8±11cm/s [4/11]; p=0.6). We created mathematical, three-dimensional RA reconstruction-velocity model measurements. In each block localization, when the block line was absent, velocity was significantly slowed (≤20cm/s). A systematic slowdown in conduction velocity was observed at the entrance and exit of the CTI in 100% of cases. This alteration to the conduction entrance was localized at the lateral side of the CTI for the CCW AFL and at the septal side of the CTI for CW AFL. The exit-conduction alteration was localized at the CTI septal side for the CCW AFL and at the CTI lateral side for the CW AFL. The only differences between CW and CCW AFL concerned activation patterns. Conclusions The ultra-HD Rhythmia mapping system confirmed the absence of significant electrophysiological differences between CCW and CW AFL. The mechanistic posterior SV and Eustachian ridge block lines were confirmed in each arrhythmia. A systematic slowing down at the entrance and exit of the CTI was demonstrated in both CCW and CW AFL, but in reverse positions. FUNDunding Acknowledgement Type of funding sources: None.

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