Published Online
on May 10, 2004

A more recent version of this article appeared on May 25, 2004

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Submitted on September 6, 2002
Revised on February 18, 2004
Accepted on February 20, 2004

Left Septal Atrial Flutter. Electrophysiology, Anatomy, and Results of Ablation

Nassir F. Marrouche MD, Andrea Natale MD, Oussama M. Wazni MD, Jie Cheng MD, Yanfei Yang MD, Harvey Pollack MD, Atul Verma MD, Phillip Ursell MD, and Melvin M. Scheinman MD^*

From the Section of Pacing and Electrophysiology, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio (N.F.M., A.N., O.W., A.V.); Thoracic and Cardiovascular Institute, Lansing, Mich (J.C.); and Department of Pathology (H.P., P.U.) and Section of Cardiac Electrophysiology, Department of Cardiology (Y.Y., M.M.S.), University of California at San Francisco.

^* To whom correspondence should be addressed. E-mail: Scheinman{at}medicine.ucsf.edu.

Background--We describe the clinical and electrophysiological characteristics of a novel macroreentrant form of left atrial flutter circuit.

Methods and Results--A total of 11 patients were included in the study. The mean tachycardia cycle length was 278±41 ms. Nine of the 11 patients were treated with antiarrhythmic drugs at the time of the study for concomitant atrial fibrillation. With the use of entrainment pacing and either the CARTO Biosense mapping system (9 patients) or conventional mapping (2 patients), the flutter circuit was found to rotate around the left septum primum with a critical isthmus located between the pulmonary veins posteriorly and/or mitral annulus anteriorly and the septum primum. In 5 patients, radiofrequency ablation was performed from the septum primum to the right inferior pulmonary vein (group 1), and in 6 patients, a lesion was made from the septum primum to the mitral annulus (group 2). After a follow-up of 13±6 months, 2 patients in group 1 and all patients in group 2 remained in sinus rhythm without recurrence.

Conclusions--Slowing of electric conduction in the left atrial septum due to antiarrhythmic drugs and/or atrial myopathy seems to promote left septal atrial flutter. Radiofrequency ablation of this arrhythmia is usually effective and safe. A line of block between the septum primum and the mitral annulus proved to be effective for cure of tachycardia.

Key words: atrial flutter • ablation • electrophysiology

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