PMID: 9535484Apr 16, 1998Paper

Electrical-anatomic correlations between typical atrial flutter and intra-atrial re-entry following atrial surgery

Journal of Electrocardiology
G F Van Hare

Abstract

It is well known that in typical (or type I) atrial flutter, conduction proceeds counterclockwise, up the interatrial septum and down the right atrial wall anterior to the crista terminalis (CT). Recent careful mapping studies using entrainment pacing have clearly shown the importance of the CT and the eustachian valve ridge (EVR), which act as fixed barriers to intra-atrial conduction and interact with other barriers, including the tricuspid valve, inferior vena cava (IVC), and coronary sinus os, to create a long macroreentrant circuit. Ablative lesions are directed at the isthmus between the tricuspid valve and the IVC or between the tricuspid valve and the EVR. Patients who have had cardiac surgery may have typical atrial flutter, either counterclockwise or clockwise, and prior surgery may act to stabilize the circuit. Such patients may also have atypical flutter, which does not utilize this circuit. Surgical closure of septal defects requires a long anterior oblique atriotomy. Commonly, reentrant circuits are identified that use this barrier, as well as the tricuspid valve and CT, and are confined to the anterior atrial wall and do not involve the typical flutter isthmus. These may be ablated at the lower or the upper end o...Continue Reading

References

Mar 15, 1990·Journal of the American College of Cardiology·B OlshanskyA L Waldo
Sep 15, 1990·The American Journal of Cardiology·F G CosioR Chicote
May 1, 1971·Thorax·F Fontan, E Baudet
Apr 1, 1994·Journal of the American College of Cardiology·S BalajiP C Gillette
Mar 1, 1996·The Journal of Thoracic and Cardiovascular Surgery·M D RodefeldC B Huddleston
May 1, 1964·British Heart Journal·R M SHAHER

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Citations

Sep 4, 2010·Journal of the American College of Cardiology·George F Van Hare
Jul 30, 2014·Herzschrittmachertherapie & Elektrophysiologie·Joachim HebeKlaus Langes

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