Atrial tachycardias: macroreentrant atrial tachycardias, CTI-dependent atrial flutter (clockwise, anticlockwise), and non-CTI-dependent macroreentrant atrial tachycardia

ESC CardioMed ◽  
2018 ◽  
pp. 2075-2082
Author(s):  
Jose L. Merino
Keyword(s):  
Atrial Flutter ◽  
Atrial Tachycardia ◽  
Heart Diseases ◽  
Vena Cava ◽  
Common Type ◽  
Tricuspid Annulus ◽  
Significant Morbidity ◽  
Structural Heart Diseases ◽  
The Right ◽  
Invasive Evaluation

Macroreentrant atrial tachycardia is, after atrial fibrillation, the most common sustained form of supraventricular tachycardia. It is often associated with significant morbidity and mortality. Originally, atrial flutter was the most used term but has been discouraged in favour of the most generally applied macroreentrant atrial tachycardia and the definition and diagnosis changed from an electrocardiogram-based to an electrophysiological one after invasive evaluation. The most common type of macroreentrant atrial tachycardia is cavotricuspid isthmus (CTI)-dependent atrial flutter. The reentrant circuit of CTI-atrial flutter revolves around the tricuspid annulus in the counterclockwise or the less common clockwise direction. The treatment of choice for most presentations of CTI-dependent flutter is catheter ablation by linear radiofrequency application of the isthmus between the tricuspid annulus and the inferior vena cava. Different reentrant circuits of non-CTI-dependent macroreentrant atrial tachycardia have been reported in both the right and the left atrium. They are often associated with different structural heart diseases.

Linear Ablation of the Isthmus Between the Inferior Vena Cava and Tricuspid Annulus for the Treatment of Atrial Flutter

Circulation ◽  
1995 ◽  
Vol 92 (5) ◽  
pp. 1312-1319 ◽  
Author(s):  
Toshifumi Tabuchi ◽  
Ken Okumura ◽  
Toshiro Matsunaga ◽  
Ryusuke Tsunoda ◽  
Michihisa Jougasaki ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Atrial Flutter ◽  
Inferior Vena ◽  
Vena Cava ◽  
Tricuspid Annulus ◽  
Linear Ablation

Two decades of experience on ablation in children with Ebstein’s anomaly

2021 ◽  
pp. 1-7
Author(s):  
Tevfik Karagöz ◽  
İlker Ertuğrul ◽  
Ebru Aypar ◽  
Aydın Adıgüzel ◽  
Hayrettin Hakan Aykan ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Atrial Tachycardia ◽  
Ebstein’S Anomaly ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Success Rates ◽  
Recurrence Rates ◽  
Ebstein's Anomaly ◽  
Accessory Pathways ◽  
Rare Occasion ◽  
The Right

Abstract Introduction: Accessory pathways are commonly seen due to delamination of tricuspid valve leaflets. In addition to accessory pathways, an enlarged right atrium due to tricuspid regurgitation and incisional scars creates substrates for atrial re-entries and ectopic tachycardia. We sought to describe our experience with catheter ablation in children with Ebstein’s anomaly. Methods and results: During the study period, of 89 patients diagnosed with Ebstein’s anomaly, 26 (30.9%) of them who underwent 33 ablation procedures were included in the study. Accessory pathways were observed in the majority of procedures (n = 27), whereas atrial flutter was observed in five, atrioventricular nodal reentrant tachycardia in five, and atrial tachycardia in two procedures. Accessory pathways were commonly localised in the right posteroseptal (n = 10 patients), right posterolateral (n = 14 patients), septal (n = two patients), and left posteroseptal (n = one patient) areas. Multiple accessory pathways and coexistent arrhythmia were observed in six procedures. All ablation attempts related to the accessory pathways were successful, but recurrence was observed in five (19%) of the ablations. Ablation for atrial flutter was performed in five patients; two of them were ablated successfully. One of the atrial tachycardia cases was ablated successfully. Conclusions: Ablation in patients with Ebstein’s anomaly is challenging, and due to nature of the disease, it is not a rare occasion in this group of patients. Ablation of accessory pathways has high success, but also relatively high recurrence rates, whereas ablation of atrial arrhythmias has lower success rates, especially in operated patients.

scholarly journals Coughing as a potentially effective induction method of atrial tachycardia: a case report

2020 ◽  
Author(s):  
Reina Tonegawa-Kuji ◽  
Kenichiro Yamagata ◽  
Kengo Kusano
Keyword(s):  
Pulmonary Vein ◽  
Atrial Tachycardia ◽  
Superior Vena ◽  
Vena Cava ◽  
P Wave ◽  
Induction Method ◽  
Voluntary Cough ◽  
Wave Morphology ◽  
The Right

Abstract Background  Cough-induced atrial tachycardia (AT) is extremely rare and its electrical origin remains largely unknown. Atrial tachycardias triggered by pharyngeal stimulation, such as swallowing or speech, appears to be more common and the majority of them originate from the superior vena cava or right superior pulmonary vein (PV). Only one case of swallow-triggered AT with right inferior pulmonary vein (RIPV) origin has been reported to date. Case summary  We present a case of a 41-year-old man with recurring episodes of AT in the daytime. He underwent electrophysiology study without sedation. Atrial tachycardia was not observed when the patient entered the examination room and could not be induced with conventional induction procedures. By having the patient cough periodically on purpose, transient AT with P-wave morphology similar to the clinical AT was consistently induced. Activation mapping of the AT revealed a centrifugal pattern with the earliest activity localized inside the RIPV. After successful radiofrequency isolation of the right PV, AT was no longer inducible. Discussion  In the rare case of cough-induced AT originating from the RIPV, the proximity of the inferior right ganglionated plexi (GP) suggests the role of GP in triggering tachycardia. This is the first report that demonstrates voluntary cough was used to induce AT. In such cases that induction of AT is difficult using conventional methods, having the patient cough may be an effective induction method that is easy to attempt.

scholarly journals P649 Before and after: sinus venosus atrial septal defect

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
I Marco Clement ◽  
R Eiros ◽  
R Dalmau ◽  
T Lopez ◽  
G Guzman ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Left Atrium ◽  
Atrial Flutter ◽  
Superior Vena Cava ◽  
Right Atrium ◽  
Septal Defect ◽  
Superior Vena ◽  
Pulmonary Veins ◽  
Vena Cava ◽  
The Right

Abstract Introduction The diagnosis of sinus venosus atrial septal defect (SVASD) is complex and requires special imaging. Surgery is the conventional treatment; however, transcatheter repair may become an attractive option. Case report A 60 year-old woman was admitted to the cardiology department with several episodes of paroxysmal atrial flutter, atrial fibrillation and atrioventricular nodal reentrant tachycardia. She reported a 10-year history of occasional palpitations which had not been studied. A transthoracic echocardiography revealed severe right ventricle dilatation and moderate dysfunction. Right volume overload appeared to be secondary to a superior SVASD with partial anomalous pulmonary venous drainage. A transesophageal echocardiography confirmed the diagnosis revealing a large SVASD of 16x12 mm (Figure A) with left-right shunt (Qp/Qs 2,2) and two right pulmonary veins draining into the right superior vena cava. Additionally, it demonstrated coronary sinus dilatation secondary to persistent left superior vena cava. CMR and cardiac CT showed right superior and middle pulmonary veins draining into the right superior vena cava 18 mm above the septal defect (Figures B and C). After discussion in clinical session, a percutaneous approach was planned to correct the septal defect and anomalous pulmonary drainage. For this purpose, anatomical data obtained from CMR and CT was needed to plan the procedure. During the intervention two stents graft were deployed in the right superior vena cava. The distal stent was flared at the septal defect level so as to occlude it while redirecting the anomalous pulmonary venous flow to the left atrium (Figure D). Control CT confirmed the complete occlusion of the SVASD without residual communication from pulmonary veins to the right superior vena cava or the right atrium (Figure E). Anomalous right superior and middle pulmonary veins drained into the left atrium below the stents. Transthoracic echocardiographies showed progressive reduction of right atrium and ventricle dilatation. The patient also underwent successful ablation of atrial flutter and intranodal tachycardia. She is currently asymptomatic, without dyspnea or arrhythmic recurrences. Conclusions In this case, multimodality imaging played a key role in every stage of the clinical process. First, it provided the diagnosis and enabled an accurate understanding of the patient’s anatomy, particularly of the anomalous pulmonary venous connections. Secondly, it allowed a transcatheter approach by supplying essential information to guide the procedure. Finally, it assessed the effectiveness of the intervention and the improvement in cardiac hemodynamics during follow-up. Abstract P649 Figure.

scholarly journals A Case Report of Radiofrequency Ablation of Typical Atrial Flutter Combined with Atrial Tachycardia

2021 ◽  
Author(s):  
Chen Chun-hui
Keyword(s):  
Radiofrequency Ablation ◽  
Atrial Flutter ◽  
Cycle Length ◽  
Atrial Tachycardia ◽  
Tricuspid Annulus ◽  
Crista Terminalis ◽  
Typical Atrial Flutter ◽  
History Of ◽  
Focal Atrial Tachycardia ◽  
Endocardial Mapping

A 63-year-old female patient with a history of pulmonary heart disease underwent radiofrequency ablation because ofa persistent atrial flutter. Endocardial mapping with the carto3 system confirmed atrial flutter counterclockwise reentryaround the tricuspid annulus. Routine ablation of the cavo-tricuspid isthmus line to bi-directional block was performed.However, tachycardia with the same cycle length was induced again. After remapping, the tachycardia was confirmedto be focal atrial tachycardia located in the crista terminalis. After ablation, the tachycardia was terminated and couldnot be induced again.

scholarly journals Atrial Tachycardia Arising From the Right Atrial Inferoseptum Masquerading as Common Atrial Flutter

2007 ◽  
Vol 71 (1) ◽  
pp. 160-165 ◽  
Author(s):  
Sachiko Ito ◽  
Hiroshi Tada ◽  
Akihiko Nogami ◽  
Shigeto Naito ◽  
Shigeru Oshima ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Atrial Tachycardia ◽  
Right Atrial ◽  
The Right

scholarly journals Anatomical variations of the right coronary artery may be a source of difficult block and conduction recurrence in catheter ablation of common-type atrial flutter

EP Europace ◽  
2010 ◽  
Vol 12 (11) ◽  
pp. 1608-1615 ◽  
Author(s):  
H. U. Klemm ◽  
T. F. Weber ◽  
C. Johnsen ◽  
P. G. C. Begemann ◽  
T. Meinertz ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Catheter Ablation ◽  
Atrial Flutter ◽  
Right Coronary Artery ◽  
Anatomical Variations ◽  
Common Type ◽  
The Right

scholarly journals Results of radiofrequency ablation of ectopic atrial tachycardia originating from the left superior vena cava in a patient with congenital heart disease

2021 ◽  
Vol 28 (3) ◽  
pp. 67-72
Author(s):  
E. V. Lubkina ◽  
S. Yu. Serguladze ◽  
Zh. Kh. Tembotova ◽  
I. I. Maslova ◽  
V. G. Suladze ◽  
...  
Keyword(s):  
Superior Vena Cava ◽  
Cardiac Arrhythmias ◽  
Atrial Tachycardia ◽  
Congenital Heart ◽  
Superior Vena ◽  
Vena Cava ◽  
Left Superior Vena Cava ◽  
Ectopic Atrial Tachycardia ◽  
The Right ◽  
Dilated Coronary Sinus

Persistent left superior vena cava (PLSVC) is the most common anomaly of the thoracic veins (occurs in 0.2-0.6% of cases in the general population), in the vast majority of cases, PLSVC drains into the right atrium through the dilated coronary sinus and usually does not lead to significant hemodynamic disorders. The presence of PLSVC is often associated with cardiac arrhythmias; in this clinical case, we present the results of catheter ablation of arrhythmogenic foci in a 72-year-old patient with continuous-recurring ectopic tachycardia originating from the PLSVC.

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