title: Cavotricuspid isthmus conduction split by pouch-like recesses during typical atrial flutter.
abstract: A 58-year-old man had typical cavotricuspid-isthmus-dependent atrial flutter (AFL). Right atrial angiography and multidetector computed tomography revealed a deep pouch-like recess in the mid-isthmus region. Linear ablation from the pouch to the edge of the inferior vena cava resulted in widely split double potentials without any change in the AFL cycle length. This observation suggested that the pouch played an electrophysiological role by dividing the flutter wavefront into 2 parallel conduction wave fronts through both sides of the pouch along the isthmus during typical AFL. When a widely split potential is created on 1 side of the pouch, the other side of the pouch should be targeted.
authors.affiliation: Division of Cardiology, Yokohama Rosai Hospital, Kohoku-ku, Yokohama, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Oginosawa
authors.forename: Akihiko
authors.initials: A
authors.lastname: Nogami
authors.forename: Kenji
authors.initials: K
authors.lastname: Kurosaki
authors.forename: Aiko
authors.initials: A
authors.lastname: Sugiyasu
authors.forename: Shoichi
authors.initials: S
authors.lastname: Kubota
authors.forename: Shinya
authors.initials: S
authors.lastname: Kowase
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Yamasaki
authors.forename: Shiho
authors.initials: S
authors.lastname: Takada
authors.forename: Jun
authors.initials: J
authors.lastname: Suzuki
authors.forename: Mihoko
authors.initials: M
authors.lastname: Sakamaki
authors.forename: Hajime
authors.initials: H
authors.lastname: Aoki
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yumoto
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Tamaki
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kato
mesh_terms: D000792:Angiography; D001282:Atrial Flutter / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D017115:Catheter Ablation; D004562:Electrocardiography; D055724:Electrophysiological Phenomena; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D014682:Vena Cava, Inferior / Q000473:pathology / Q000503:physiopathology