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Article Abstract
Atypical atrial flutter (AFL) can be challenging to ablate, especially when involving dual-loop re-entry. We sought to assess the electroanatomical characteristics of single- and dual-loop AFLs in patients undergoing catheter ablation. We analyzed 25 non-cavotricuspid isthmus-dependent macro-re-entrant AFL in 19 consecutive patients. Three-dimensional high-density activation mapping was performed, and active re-entry loops were confirmed by entrainment mapping. Of 25 AFLs (24 left, 1 right atrial), 13 (52%) exhibited dual-loop re-entry. The most common circuits included, in 6/13 (46% of dual loops), a perimitral re-entry with a second loop around the right/left pulmonary veins (PV) and, in 6/13 (46%), involved a right PV ostium with a second loop around either a functional conduction block or another PV. Ablation at the common isthmus of dual-loop AFLs and at the critical isthmus of single-loop AFLs terminated the arrhythmia more frequently than ablation at a secondary isthmus of dual-loop AFLs (5/6 (83%) and 8/11 (73%) versus 1/8 (13%), respectively, = 0.013). More than half of AFLs exhibited a dual-loop re-entrant mechanism. Most critical isthmuses were found at the mitral isthmus, the left atrial roof or right PV ostia. Ablation targeting the common isthmus resulted in a higher termination rate.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11121780 | PMC |
| http://dx.doi.org/10.3390/jcm13102847 | DOI Listing |
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Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland.
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J Clin Med
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Atypical atrial flutter (AFL) can be challenging to ablate, especially when involving dual-loop re-entry. We sought to assess the electroanatomical characteristics of single- and dual-loop AFLs in patients undergoing catheter ablation. We analyzed 25 non-cavotricuspid isthmus-dependent macro-re-entrant AFL in 19 consecutive patients.
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Division of Cardiac Electrophysiology, Loyola University Medical Center, Maywood, Illinois, USA.
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Directed Graph Mapping for Ventricular Tachycardia: A Comparison to Established Mapping Techniques.
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Department of Physics and Astronomy, Ghent University, Ghent, Belgium.
Article Synopsis
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Rapid detection of isthmus block and rhythm change using local electrogram changes during complex atrial flutter ablation.
Europace
February 2023
Division of Cardiology, Ascension St Vincent, 8333 Naab Road, #400, Indianapolis, IN 46260, USA.
Aims: Multiple re-entry circuits may operate simultaneously in the atria in the form of dual loop re-entry using a common isthmus, or multiple re-entrant loops without a common isthmus. When two or more re-entrant circuits coexist, ablation of an individual isthmus may lead to a seamless transition (without significant changes in surface electrocardiogram, coronary sinus activation or tachycardia cycle length) to a second rhythm, and the isthmus block can go unnoticed.
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