Uncommon atrial flutter: characteristics, mechanisms, and results of ablative therapy.
Thirty-seven patients with atrial flutter were studied with catheter mapping and radiofrequency ablation. Uncommon atrial flutter occurred in 20 out of 37 (54%) patients. Atrial endocardial mapping showed two types of uncommon atrial flutter. In 15 patients (group I) it was characterized by a single clockwise circuit whereas in 5 patients (Group II) it was characterized by the presence of more than one circuit and/or localized atrial fibrillation. RFA ablation was acutely successful in 14 out of 15 patients (93%) in Group I and in 2 out of 5 (40%) patients in Group II. On long-term follow-up a significantly larger number of patients in Group I versus Group II (86% vs 20%) remained free of atrial flutter recurrence. We conclude that uncommon atrial flutter is a heterogeneous entity involving one or more reentrant circuits. Uncommon atrial flutter with multiple circuits may not be suitable for RFA.
Gomes
J A
JA
Department of Medicine, Mount Sinai Medical Center, New York, New York, USA. ANTHONY GOMES@smtplink.mssm.edu
Santoni-Rugiu
F
F
Mehta
D
D
Langan
N M
NM
Marx
S O
SO
Nayak
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D001282:Atrial Flutter / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D018780:Body Surface Potential Mapping; D002036:Bundle of His / Q000503:physiopathology; D017115:Catheter Ablation; D004452:Echocardiography; D004562:Electrocardiography; D004699:Endocardium / Q000294:innervation; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000294:innervation; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome