scholarly journals Macro-reentrant Single-loop Biatrial Flutter Appearing as Typical Atrial Flutter: Case Study and Review

2020 ◽  
Vol 11 (11) ◽  
pp. 4306-4312
Author(s):  
Aneesh Tolat ◽  
Elizabeth Clark ◽  
Vamsi Naraparaju ◽  
Joseph Flack
Keyword(s):  
Atrial Flutter ◽  
Atrial Tachycardia ◽  
Rapid Diagnosis ◽  
Rare Form ◽  
Single Loop ◽  
Density Mapping ◽  
Typical Atrial Flutter ◽  
Bachmann’S Bundle ◽  
The Right

Biatrial flutter is a rare form of macro-reentrant atrial tachycardia that involves both the right and left atria. Single-loop biatrial flutter is typically associated with scarring of the septum from prior ablation or surgery and is generally made up of two interatrial connections—that is, the coronary sinus and Bachmann’s bundle. Entrainment and high-density mapping allow for rapid diagnosis and development of a treatment strategy. Ablation planning should also take into consideration the preservation of interatrial conduction. We herein discuss a case of single-loop biatrial flutter presenting as a typical atrial flutter and review the differential diagnosis and physiology of the arrhythmia.

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.

P957Characteristics of atrial tachycardia after mitral surgey via biatrial trans-septal approach using high density mapping system

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Cataldi ◽  
M Andronache ◽  
R Eschalier ◽  
F Jean ◽  
R Bosle ◽  
...  
Keyword(s):  
Atrial Tachycardia ◽  
Sinus Node ◽  
Pulmonary Veins ◽  
High Density ◽  
Congenital Defects ◽  
Density Mapping ◽  
Mapping System ◽  
Oblique Incision ◽  
Pace Maker ◽  
The Right

Abstract Background The biatrial trans-septal approach (BTSa) ameliorates mitral valve (MV) exposure in difficult cases when routine left atriotomy doesnt"t allow it. Main steps are an oblique incision on the right atrium (RA), reaching medially the right pulmonary veins (PV), a septal incision from the fossa ovalis, extended up to reach the first incision, then on the left atrium (LA). Purpose We aim to study the arrhythmic burden in this post-surgical context, focusing on atrial tachycardia (AT), to investigate the complexity of several possible circuits. Methods All patients (>18yo) with previous MV surgery via BTSa for MV repair or replacement, who underwent ablation of AT from January 2017 to September 2019, were enrolled. Patients ablated for persistent or paroxysmal AF, or with AF during the index procedure were excluded. Patients with associated surgery on other valves or congenital defects, coronary, surgical or percutaneous rhythm interventions weren’t excluded. Electroanatomical mapping was created using 2 different high-density mapping system. Substrate and activation map and radio-frequency (RF) ablation (25-50W, Ablation Index target 400) were realized. Cartographies were analysed to evaluate AT re-entry circuit, critical isthmus (CI) location and characterization, atrial vulnerability. Procedural outcomes (AT termination, sinus rhythm (SR) restoration, anti-arrhythmic drugs (AAD) withdrawal), and peri-procedural complications were also evaluated. Results We enrolled 49 patients (median age 57 ± 15), finding a maximum of 5 AT per procedure (2 ± 1). A total of 112 AT were mapped: the majority (72%) were persistent AT, 8,2% common atrial flutter. Cycle length was 314 ± 74 msec, with proximal-distal activation of coronary sinus (78%). A multiple re-entry circuit was observed in 70% of index AT. We identified 152 critical isthmus (maximum 5 per procedure). Only 27,9% of our patients had a single CI; CTI was the most frequent one (n = 37), envolved in 33% of all AT, while BTS scars altogether were envolved in 65% AT. A complete AT circuit was mapped in the RA, the LA and both atria in respectively 49%, 11,5% and 39%AT. The distribution of CIs is shown in figure 1. Biatrial and left AT leads to superior procedure, RF and fluoroscopy duration (p <0,05). SR was restored in 93,4%of patients, requiring a DC shock in 4 cases. Immediate AAD withdrawal was achieved after 41%procedures. No pericardial, oesophageal, vascular or phrenic complication occurred. 4 pace-maker implantations were realized because of 3 interatrial, 2 AV block and a sinus node dysfunction. Conclusions AT occurring after a BTSa have a high prevalence of multiple re-entry circuits with multiple critical isthmus. Ablation in this context is feasible and safe but often requires a left atrial access. Mapping of both atria should be considered to identify critical isthmus and tailored ablation strategy. Abstract Figure 1. Critical Isthmus Distribution

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.

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.

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 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

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 Radiofrequency Ablation of Typical Atrial Flutter via Right Jugular Vein due to Bilateral Obstructed Iliac Veins in a Patient with Dilated Cardiomyopathy

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Tolga Aksu ◽  
Tumer Erdem Guler ◽  
Sukriye Ebru Golcuk ◽  
Kazım Serhan Ozcan ◽  
Ismail Erden
Keyword(s):  
Radiofrequency Ablation ◽  
Dilated Cardiomyopathy ◽  
Atrial Flutter ◽  
Gold Standard ◽  
Jugular Vein ◽  
Venous Access ◽  
Gold Standard Method ◽  
Typical Atrial Flutter ◽  
The Right ◽  
Superior Approach

Ablation of cavotricuspid isthmus (CTI) is the gold standard method in the treatment of isthmus dependent atrial flutter (AFl). Venous access was obtained usually via right or left femoral veins. In rare cases of obstruction of iliofemoral veins, ablation of CTI can be performed only through the superior approach. We present a 74-year-old woman of typical AFl and dilated cardiomyopathy that was ablated through the right jugular vein because of obstruction of the left and the right iliac veins. This is the first report of successful ablation of CTI in a patient with dilated cardiomyopathy via superior approach.

Outcome after practical isthmus ablation of scar-related atrial tachycardia guided by high-density mapping

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Jungen ◽  
R Akbulak ◽  
A Kahle ◽  
C Eickholt ◽  
B Schaeffer ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Atrial Tachycardia ◽  
Outcome Data ◽  
High Density ◽  
Density Mapping ◽  
Number Of Patients ◽  
Basket Catheter ◽  
Acute Success ◽  
The Right ◽  
Mean Cycle

Abstract Background High-density mapping (HDM) has been found to precisely identify the practical isthmus of scar-related atrial tachycardia (AT) circuits. Since practical isthmuses have been found to be shorter than the usual anatomical isthmuses targeted ablation has been proposed. However, outcome data are sparse. Here we describe HDM-guided catheter ablation by targeting the practical isthmus in patients with scar-related ATs. Methods and results In 250 consecutive patients with scar-related ATs HDM-guided catheter ablation with the support of a 64-electrode mini-basket catheter has been performed. Most patients underwent a prior catheter ablation (98%) while 13% had a prior cardiac valve surgery and 6% an underlying congenital heart disease. A total of 355 ATs occurred in the index procedure, of which 64% had a macro-, 26% a micro-reentry and 10% a focal mechanism. The ATs had a mean cycle length of 304±4.3 ms and in 237 patients (95%) an acute termination into sinus rhythm was achieved. They were mainly located in the left atrium (72%) but also in the right atrium (25%), bi-atrially (5%) or in the CS (3%) (see figure). Targeting the practical isthmus revealed arrhythmia freedom in 53% of patients after a single procedure during a mid-term follow-up (median 489 days, range 95–1407 days). Freedom from any arrhythmia could be achieved in 74% of patients after multiple procedures and in 93% of patients after multiple procedures and optimal clinical therapy, including pharmaceutical or electrical cardioversion. Conclusions HDM-guided catheter ablation of the practical isthmus in patients with scar-related ATs leads to a high acute success rate. Nevertheless, multiple procedures are necessary in a relevant number of patients resulting in a low recurrence rate. Funding Acknowledgement Type of funding source: None

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