#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Catheter-based treatment of common atrial flutter yesterday and today


Authors: Z. Stárek;  L. Zaoral;  M. Eisenberger;  P. Leinveber;  M. Novák
Authors‘ workplace: I. interní kardioangiologická klinika FN u sv. Anny, Brno
Published in: Kardiol Rev Int Med 2006, 8(Supplementum): 24-27

Overview

Common atrial flutter is a frequent and clinically significant arrhythmia. It is macroreentrant atrial tachycardia circulating around the right atrium along anatomically pathway defined by anatomical barriers and with an area of slow conduction within the cavotricuspid isthmus. There has been an extensive development of non-pharmacological methods due to low efficacy and potencial risks of pharmacotherapy. From open heart surgery and high voltage current catheter ablations we have moved to today´s standard - radiofrequency catheter ablation of cavotricuspid isthmus using linear lesions aiming to achieve bidirectional block. At present, it is fast, efficient and safe procedure in therapy of common atrial flutter. The risk of recurrence after successful ablation is below 5 %. The use of large-tip and irrigated-tip catheters facilitates and fastens the achievement of isthmus block. The complication rate of this method is very low.

Key words:
catheter ablation - common atrial flutter - radiofrequency current


Sources

1. Jolly WA, Ritchie WJ. Auricular flutter and fibrillation. Hearth 1911; 2: 177-221.

2. Bellet S. Clinical Disorders of the Heart Beat. Philadelphia: Lea & Febiger 1963: 144–145.

3. Roden DM. Risks and benefits of antiarrhytmic therapy. N Engl J Med 1994: 331: 785-791.

4. Lewis T, Drury AN, Iliescu CC. A demonstration of circus movement in clinical flutter of the auricles. Heart 1921; 8: 341-359.

5. Waldo AL, MacLean WAH, Karp RB et al. Entrainment and interruption of atrial flutter with atrial pacing. Studies in man following open heart surgery. Circulation 1977; 56: 737-745.

6. Disertori M, Inama G, Vergara G et al. Evidence of a reentry circuit in the common type of atrial flutter in man. Circulation 1983; 67: 434-440.

7. Olshansky B, Okumura K, Hess PG, Waldo AL. Demonstration of an area of slow conduction in human atrial flutter. J Am Coll Cardiol 1990; 16: 1639-1648.

8. Olgin JE, Kalman JM, Fitzpatrick AP, Lesh MD. Role of right atrial endocardial structures as barriers to conduction during human type I atrial flutter: activation and entrainment mapping guided by intracardiac echocardiography. Circulation 1995; 92: 1839–1848.

9. Olgin JE, Kalman JM, Lesh MD. Conduction bariers in human atrial flutter: Correlation of electrophysiology and anatomy. J Cardiovasc Electropfysiol 1996; 7: 1112-1126.

10. Cosio FG, Goicolea A, Lopez-Gil M et al. Atrial endocardial mapping in the rare form of atrial flutter. Am J Cardiol 1990; 66: 715-720.

11. Tai CT, Chen SA, Chiang CE et al. Electrophysiologic charakteristics and radiofrequency catheter ablation in patients with clockwise atrial flutter. J Cardiovasc Electrophysiol 1996; 8: 24-34.

12. Cabrera JA, Sanchez-Quintana D, Ho SY et al. The architecture of the atrial musculature between the orifice of the inferior caval vein and the tricuspid valve: The anatomy of the isthmus. J Cardiovasc Electrophysiol 1998; 9: 1186-1195.

13. Waki K, Saito T, Becker AE et al. Right atrial isthmus revisited: normal anatomy favors nonuniform anisotropic conduction. J Cardiovasc Electrophysiol 2000; 11: 90-94.

14. Cobb RF, Blumenschein SD, Sealy WC et al. Succesful surgical interruption of the bundle of Kent in a patient with Wolff-Parkinson-White syndrome. Circulation 1968; 38: 1018-1029.

15. Klein JG, Guiradon GM, Arjun D et al. Demonstration of macroreentry and feasibility of operative therapy in the common type of atrial flutter. Am J Cardiol 1986; 57: 587-591.

16. Scheinman MM, Morady F, Hess DS. Catheter induced ablation of the atrioventricular junction to control refractory supraventricular arrhytmias. JAMA 1982; 248: 851-855.

17. Saoudi N, Mouton Schleiffer D, Letac B. Direct catheter fulguration og atrial flutter. Lancet 1987; 2: 568-569.

18. Saoudi N, Atallah G, Kirkorian G, Touboul P. Catheter ablation of the atrial myocardium in human type I atrial flutter. Circulation 1990; 81: 762-771.

19. Boyd EG, Holt PM. An investigation into the electrical ablation technique and a method of electrode assessment. Pacing Clin Electrophysiol 1985; 8: 815-824.

20. Huang SK, Bharati S, Graham AR et al. Closed chest catheter desication of the atriovetricular junction using radiofrequency energy: A new method of catheter ablation. J Am Coll Cardiol 1987; 9: 349-358.

21. GK Feld, RP Fleck, PS Chen et al. Radiofrequency catheter ablation for the treatment of human type 1 atrial flutter. Identification of a critical zone in the reentrant circuit by endocardial mapping techniques. Circulation 1992; 86: 1233-1240.

22. Calkins H, Leon AR, Deam AG. Catheter ablation of atrial flutter using radiofrequency energy. Am J Cardiol 1994; 73: 353-356.

23. Cosio FG, Lopez-Gil M, Giocolea A et al. Radiofrequency ablation of the inferior vena cava-tricuspid valve isthmus in common atrial flutter. Am J Cardiol. 1993; 71: 705–709.

24. Fischer B, Jaïs P, Shah DC et al. Radiofrequency catheter ablation of common atrial flutter in 200 patients. J Cardiovasc Electrophysiol 1996; 7: 1225–1233.

25. Poty H, Saoudi N, Aziz AA et al. Radiofrequency catheter ablation of type I atrial flutter: prediction of late success by electrophysiological criteria. Circulation 1995; 92: 1389–1392.

26. Fiala M. Doporučené postupy pro diagnostiku a léčbu supraventrikulárních tachyarytmií. Cor Vasa 2005; 47(Suppl): 18-39.

27. Blomstrom-Lundqvist C, Scheinman MM, Aliot EM et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary. a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. J Am Coll Cardiol 2003; 42: 493-531.

28. Shah D, Takahashi A, Jais P et al. Local electrogram based criteria of cavotricuspid isthmu block. J Cardiocasc Electrophysiol 1999; 10: 662-669.

29. Tai CT, Chen SA, Chiang CE et al. Long term aoutcome of radiofrequency catheter ablation for typical atrial flutter: Risk prediction of reccurent arrhytmias. J Cardiovasc Electrophysiol 1998; 9: 115-129.

30. Cosio FG, Lopez-Gil M, Arribas F et al. Ablacion de flutter auricular. Resultados a largo plazo tras 8 anos de experinca. Revista Espanola de Cardiologia 1998; 51: 832-839.

31. Heidbuchel H, Willems R, van Rensburg H et al. Right atrial angiografic evaluation of the posterior isthmus: Relevance for ablation of typical atrial flutter. Circulation 2000; 101: 2178-2184.

32. Ring ME, Huang SKS, Gorman G et al. Determinants of impedance rise during catheter ablation of bovine myocardium with radiofrequenyc energy. PACE 1989; 12: 1502-1513.

33. Kasai A, Anselem F, Teo WS et al. Comparison of effectiveness of an 8-mm versus 4-mm tip electrode catheter for radiofrequency ablation of typical atrial flutter. Am J Cardiol 2000; 86: 1029-1032.

34. Jaïs P, Shah DC, Haïssaguerre M et al. Prospective randomized comparison of irrigated-tip versus conventional-tip catheters for ablation of common flutter. Circulation. 2000; 101: 772–777.

35. Stárek Z, Zaoral L, Eisenberger M, Leinveber P. Radiofrekvenční ablace typického flutteru síní pomocí standardních a chlazených katétrů: časné a střednědobé výsledky. Cor Vasa 2005; 47: 335-341.

36. Cosio FG, Palacios J, Vidal JM et al. Electrophysiologic studies in atrial fibrillation. Slow conduction of premature impulses: A possible manifestation of the background for reentry. Am J Cardiol 1983; 51: 122-130.

37. Anselme F, Saoudi N, Poty H et al. Radiofrequency catheter ablation of common atrial flutter: Significance of palpitations and qualily-of-life evaluation in patient with proven isthmus block. Circulation 1998; 99: 534-540.

38. Steinberg JS, Prasher S, Zelenkofske S et al. Radiofrequency catheter ablation of atrial flutter: Procedural succes and long term outcome. Am Heart J 1995; 130: 85-92.

Labels
Paediatric cardiology Internal medicine Cardiac surgery Cardiology
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#