This Article Full Text Full Text (PDF) All Versions of this Article: 109/20/2440    most recent 01.CIR.0000129439.03836.96v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Marrouche, N. F. Articles by Scheinman, M. M. Search for Related Content PubMed PubMed Citation Articles by Marrouche, N. F. Articles by Scheinman, M. M. Related Collections Electrophysiology Ablation/ICD/surgery Chronic ischemic heart disease

(Circulation. 2004;109:2440-2447.)
© 2004 American Heart Association, Inc.

Clinical Investigation and Reports

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; 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.

Correspondence to Melvin M. Scheinman, MD, Section of Cardiac Electrophysiology, 500 Parnassus Ave, Room MU436, Box 1354, San Francisco, CA 94143. E-mail Scheinman{at}medicine.ucsf.edu

Received September 6, 2002; de novo received August 8, 2003; revision received February 18, 2004; accepted February 20, 2004.

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

This article has been cited by other articles:

				S. Chae, H. Oral, E. Good, S. Dey, A. Wimmer, T. Crawford, D. Wells, J.-F. Sarrazin, N. Chalfoun, M. Kuhne, et al. Atrial Tachycardia After Circumferential Pulmonary Vein Ablation of Atrial Fibrillation: Mechanistic Insights, Results of Catheter Ablation, and Risk Factors for Recurrence J. Am. Coll. Cardiol., October 30, 2007; 50(18): 1781 - 1787. [Abstract] [Full Text] [PDF]

				S.-L. Chang, C.-T. Tai, Y.-J. Lin, W. Wongcharoen, L.-W. Lo, K.-T. Lee, S.-H. Chang, T.-C. Tuan, Y.-J. Chen, M.-H. Hsieh, et al. The Role of Left Atrial Muscular Bundles in Catheter Ablation of Atrial Fibrillation J. Am. Coll. Cardiol., September 4, 2007; 50(10): 964 - 973. [Abstract] [Full Text] [PDF]