An approach to catheter ablation of cavotricuspid isthmus dependent atrial flutter.
Much of our understanding of the mechanisms of macro re-entrant atrial tachycardia comes from study of cavotricuspid isthmus (CTI) dependent atrial flutter. In the majority of cases, the diagnosis can be made from simple analysis of the surface ECG. Endocardial mapping during tachycardia allows confirmation of the macro re-entrant circuit within the right atrium while, at the same time, permitting curative catheter ablation targeting the critical isthmus of tissue located between the tricuspid annulus and the inferior vena cava. The procedure is short, safe and by demonstration of an electrophysiological endpoint - bidirectional conduction block across the CTI - is associated with an excellent outcome following ablation. It is now fair to say that catheter ablation should be considered as a first line therapy for patients with documented CTI-dependent atrial flutter.
O'Neill
Mark D
MD
Hôpital Cardiologique du Haut Lévêque & Université Victor Segalen Bordeaux II, 33604 Bordeaux, Pessac, France. mdconeill@btinternet.com
Jais
Pierre
P
Jönsson
Anders
A
Takahashi
Yoshihide
Y
Sacher
Frédéric
F
Hocini
Mélèze
M
Sanders
Prashanthan
P
Rostock
Thomas
T
Rotter
Martin
M
Clémenty
Jacques
J
Haïssaguerre
Michel
M