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ECG-Based Origin of Atrial Flutter
Published in Andrea Natale, Oussama M. Wazni, Kalyanam Shivkumar, Francis E. Marchlinski, Handbook of Cardiac Electrophysiology, 2020
Decebal Gabriel Laţcu, Nadir Saoudi, Francis E. Marchlinski
This classic appearance may show morphologic variations, especially in regards to the presence and the amplitude of the terminal positive deflection in the inferior leads. A classification into three subtypes of ECG patterns for CCW cavo-tricuspid isthmus (CTI) dependent flutters was proposed.11 A terminal positive component of the F-wave in typical CCW flutter seems to identify a patient population with a relatively high likelihood of heart disease, higher incidence of atrial fibrillation (AF) and LA enlargement. It should be stressed that severe atrial disease/conduction disturbances but also previous AF ablation12 may yield unusual ECG patterns and the typical circuit may then be difficult to diagnose. Even atypical (e.g., LA flutters, especially in the presence of a pre-existing CTI block1) circuits may mimic typical CCW flutter.
Catheter ablation therapy
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
In Figure 44.6, a typical example of fluoroscopic X-ray of an atrial flutter ablation is shown. A duo-decapolar catheter is placed on the lateral wall of the right atrium and a second decapolar catheter is placed in the ostium of the coronary sinus. This gives multiple points of reference proximal and distal to the ablation target, which is the cavo-tricuspid isthmus, a narrow band of muscular tissue between the inferior vena cava and the tricuspid annulus.
Fundamentals of cardiac electrophysiology
Published in Ever D. Grech, Practical Interventional Cardiology, 2017
Sunil Kapur, William G Stevenson, Roy M John
Right Atrium: The right atrium (RA) is bounded by the caval veins superiorly and inferiorly, the inter-atrial septum and coronary sinus medially and the crista terminalis laterally.1 The smooth posterior wall is derived from the sinus venosum. The pectinated anterolateral portion is dominated by the right atrial appendage. The crista terminalis (terminal crest) is a well-defined fibromuscular ridge that extends from the atrial septal wall medially, courses anterior to the superior vena cava (SVC), descends inferiorly along the lateral wall and then courses anterior to the inferior vena cava (IVC) towards the septum where it meets the lateral horn of crescentic remnant of the Eustachian valve. The medial horn of the Eustachian valve joins the Thebesian valve at the orifice of the coronary sinus. The superior aspect of the crista terminalis anterior to the SVC contains the sinus node cells, but throughout its course it may contain other cells capable of automaticity giving rise to escape rhythms and ectopic atrial tachycardias. The sub-Eustachian isthmus between the opening of the IVC and the adjacent tricuspid annulus, commonly referred to as the cavo-tricuspid isthmus, is part of the re-entry path for common right atrial flutter and is targeted by ablation to treat this arrhythmia.
Real world data on non-complex catheter ablations performed on zero fluoroscopy in a secondary centre in the south of Belgium
Published in Acta Cardiologica, 2021
Lucio Capulzini, Christophe de Terwangne, Gianbattista Chierchia, Carlo de Asmundis, Gaetano Paparella, Antonio Sorgente
Acute success of the procedure was defined according to the different treated arrhythmia. No predefined waiting time after the last radiofrequency application was considered. Use of isoproterenol infusion up to 3 μg/min and/or adenosine 6 mg intravenous bolus after the last radiofrequency application was left at the discretion of the operator. In case of SVT and manifest atrio-ventricular accessory pathways, acute success was defined as lack of inducibility of the original induced supraventricular tachycardia and disappearance of the manifest atrio-ventricular pre-excitation. In case of concealed atrio-ventricular accessory pathways, acute success was considered absence of retrograde conduction in the atrium when the right ventricle was paced, normalisation of retrograde activation with decremental conduction, or earliest activation at the His bundle and ventriculo-atrial block. In case of right cavo-tricuspid isthmus dependent atrial flutters, acute success was defined as presence of bidirectional block along the cavo-tricuspid line. In case of PVCs, acute success was defined as disappearance of the clinical PVCs.
The long term risk of lead failure in patients with cardiovascular implantable electronic devices undergoing catheter ablation
Published in Scandinavian Cardiovascular Journal, 2019
Michal M. Farkowski, Aleksander Maciag, Jan Ciszewski, Ilona Kowalik, Pawel Syska, Maciej Sterlinski, Hanna Szwed, Mariusz Pytkowski
Previous studies concerning only AF ablations have suggested rare occurrences of endocardial lead malfunction, either dislodgement or insulation defect, during or shortly after the procedure [3,19]. All patients required lead replacement. There were no cases of lead damage or dislodgement during the procedure in our series where 27% of procedures were conducted using the transseptal sheath (Table 2). In our opinion, careful manipulation around the right atrium with the extensive use of oblique projections for optimal positioning of guidewires and transseptal sheaths is crucial for avoiding damage to CIED leads. What is more, almost 24% of our patients had ablation of cavo-tricuspid isthmus dependent atrial flutter without short-term complications. The recent publication estimated the long-term risk of CIED lead malfunction in this population to be about 7% during 55.4 ± 38.1 months of observation [19]. This figure is comparable to our results – 8.5% (Table 3), which was observed in a diverse population of patients undergoing a wide variety of catheter ablations although the observation period was clearly shorter (Tables 2 and 3). It should be noted that, in our series percentage of ICD or CRT devices accounted for about 68% of all patients (Table 2), contrary to 27% in the cited publication, and those CIEDs are known to be at a higher risk of lead malfunction than pacemakers [13–19].
Atrio-ventricular junction ablation and pacemaker treatment: a comparison between men and women
Published in Scandinavian Cardiovascular Journal, 2018
Carina Carnlöf, Per Insulander, Mats Jensen-Urstad, Marie Iwarzon, Fredrik Gadler
The indications for AVJ ablation have changed during this long-term follow-up. In the early nineties, AVJ ablation was the only alternative when drug therapy had failed to regulate the ventricular rate in AF patients. During the latter period, interventions such as cavo-tricuspid isthmus ablation, modification of the AV node, pulmonary vein isolation, and Maze surgery had been added as alternatives before a decision to pace and ablate was made. Inadequate chocks and ATP in ICD or CRT-D patients is a more common indication for AVJ ablation in the latter cohort as well as less than 80% biventricular pacing in CRT patients.