Relationship between anatomic location of the crista terminalis and double potentials recorded during atrial flutter: intracardiac echocardiographic analysis.
BACKGROUND
The activation sequence in typical atrial flutter (AFL) around the tricuspid annulus is well described. However, activation of the remainder of the right atrium (RA) is not well defined. Previous studies have shown a linear block at the crista terminalis (CT) during AFL. The aim of this study was to evaluate the relationship between the location of the CT and the line of block by intracardiac echocardiography (ICE).


RESULTS
Twenty-one patients with typical AFL were included in the study. The ICE imaging catheter (9-French with 9-MHz ultrasound transducer) was advanced to the RA. Under ICE guidance, a 20-pole roving catheter was used to map double potentials (DPs) during AFL, and three-dimensional images of the RA were reconstructed. During counterclockwise (CCW), clockwise (CW) AFL, or both, a line of conduction block manifested by DPs was identified at a septal site adjacent to the CT in 12 patients and in the posteroseptal RA in 9 patients.


CONCLUSIONS
The functional line of block in CCW and CW AFL is localized not at the CT but at the septal edge of the CT or in the posteroseptal RA.
Okumura
Yasuo
Y
Division of Cardiovascular Disease, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Watanabe
Ichiro
I
Yamada
Takeshi
T
Ohkubo
Kimie
K
Sugimura
Hidezou
H
Hashimoto
Kenichi
K
Kofune
Tatsuya
T
Takagi
Yasuhiro
Y
Wakita
Rie
R
Oshikawa
Naohiro
N
Kawauchi
Kazunori
K
Saito
Satoshi
S
Ozawa
Yukio
Y
Kanmatsuse
Katsuo
K
Yoshikawa
Yasuyuki
Y
Asakawa
Yuko
Y
D000200:Action Potentials / Q000502:physiology*; D000328:Adult; D000368:Aged; D001282:Atrial Flutter / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002304:Cardiac Pacing, Artificial; D016009:Chi-Square Distribution; D004452:Echocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000033:anatomy & histology*; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis