Upper turnover portion of the reentry circuit for typical and reverse typical atrial flutter.
BACKGROUND
The posteromedial right atrium (PMRA) forms a block line during typical atrial flutter (AFL). However, whether upper turnover portion exists at the anterior or posterior superior vena cava (SVC) has not been determined.


METHODS
We performed right atrial mapping during AFL in 20 patients (typical AFL, n = 17; reverse typical AFL, n = 3) using an electroanatomical mapping system.


RESULTS
Mean AFL cycle length was 224 +/- 20 ms and mean number of mapping points was 140 +/- 27. PMRA formed a block line during both typical and reverse AFL in all patients. However, in 16 of 17 patients mapped with typical AFL, PMRA did not extend superiorly to the orifice of the SVC and AFL wave propagated between the upper limit of the PMRA and the posterior SVC. In the remaining patient mapped with typical AFL, a double potential was recorded along the PMRA continuously between the orifices of the inferior vena cava (IVC) and SVC. In the three patients mapped with reverse typical AFL, a posterior barrier was detected from IVC to the upper limit of the PMRA and AFL wave propagated between the upper limit of the PMRA and the posterior SVC. Mean length from IVC to upper limit of the PMRA was 81 +/- 8% of the length from IVC to SVC.


CONCLUSIONS
PMRA forms a functional block line during both typical and reverse typical AFL. The upper turnover portion of reentry circuit for AFL was observed between the upper limit of the PMRA and the posterior SVC in the majority of isthmus-dependent AFL patients.
Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan. kfuku@med.kobe-u.ac.jp
Koji
K
Fukuzawa
Akihiro
A
Yoshida
Shinya
S
Kubo
Takatsugu
T
Takano
Kunihiko
K
Kiuchi
Gaku
G
Kanda
Kaoru
K
Takami
Hiroyuki
H
Kumagai
Satoko
S
Torii
Mitsuru
M
Takami
Yoshio
Y
Ohnishi
Katsunori
K
Okajima
Ken-Ichi
K
Hirata
D001282:Atrial Flutter / Q000175:diagnosis* / Q000503:physiopathology*; D018780:Body Surface Potential Mapping / Q000379:methods*; D006325:Heart Atria / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D014683:Vena Cava, Superior / Q000503:physiopathology*; D055815:Young Adult