title: [Contribution of atrial activation to the segment of the typical atrial flutter wave: an electro-anatomic insight into the electrocardiogram morphology].
abstract: OBJECTIVE
  To investigate how the intra-cardiac activation was translates into the characterized flutter wave in patients with cavatricuspid isthmus-dependent counter-clockwise atrial flutter (CTI-AFL).
  
  
  METHODS
  A total of 15 hospitalized CTI-AFL patients (mean age: (60 ± 14) years old, 1 female) from October 2012 to February 2014 were enrolled in the study. The activation map was re-constructed during AFL rhythm for left atrium and right atrium using 3-dimensional mapping system. The flutter wave in surface electrocardiogram was analyzed in combination with the intra-cardiac activation.
  
  
  RESULTS
  The mean left ventricular ejection fraction was (60.8 ± 6.6)%, and the left atrial diameter was (39.0 ± 3.4) mm. The mean tachycardia cycle length was (220 ± 24) ms. The activation map was completed in all cases. In inferior leads, the flutter wave was divided into three parts: slowly downward part, sharp downward part and the terminal positive part. The three parts corresponded to the fixed activation part of the macro-reentry.
  
  
  CONCLUSIONS
  The distinctive flutter wave of CTI-AFL was determined by the unique macro-reentry activation in the right atrium. The activation of left atrium contributes to the downward part of the wave.
authors.affiliation: Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
authors.forename: Minglong
authors.initials: M
authors.lastname: Chen
authors.affiliation: Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Yang
authors.affiliation: Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
authors.forename: Weizhu
authors.initials: W
authors.lastname: Ju
authors.affiliation: Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
authors.forename: Fengxiang
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Yang
authors.affiliation: Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
authors.forename: Mingfang
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; Email: kjcao@njmu.edu.cn.
authors.forename: Kejiang
authors.initials: K
authors.lastname: Cao
mesh_terms: D000368:Aged; D020517:Atrial Appendage; D001281:Atrial Fibrillation; D001282:Atrial Flutter; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016277:Ventricular Function, Left