(Circulation. 1995;92:1389-1392.)
© 1995 American Heart Association, Inc.
Articles |
Radiofrequency Catheter Ablation of Type 1 Atrial Flutter
Prediction of Late Success by Electrophysiological Criteria
From Service de Cardiologie (Groupe de Recherche VACOMED), Centre Hospitalier et Universitaire de Rouen, Hopital Charles Nicolle, Rouen, France.
Correspondence to Herve Poty, MD, Service de Cardiologie (Groupe de Recherche VACOMED), Centre Hospitalier et Universitaire de Rouen, Hopital Charles Nicolle, 1 rue de Germont, 76000 Rouen, France.
Background Radiofrequency energy has demonstrated its efficacy in catheter ablation of atrial flutter (AFl). However, long-term recurrences of AFl have been reported frequently after initial, apparently successful ablation. To date, criteria for prediction of late recurrences are lacking.
Methods and Results Twelve patients (10 men; mean age, 53.6 years; range, 26 to 69 years) were referred for AFl ablation. Duodecapolar and decapolar catheters were used for detailed mapping of the tricuspid ring, the inferior vena cava–tricuspid annulus (IVC-TA) isthmus, and the coronary sinus ostium (CSOs) area. Additional multipolar catheters were used for recording activation of the coronary sinus and the CSOs-TA isthmus. AFl was present at baseline in 9 patients and was induced by proximal coronary sinus (PCS) pacing in 3. Counterclockwise right atrial activation was recorded in all patients. Primary success of ablation was defined as when AFl was no longer inducible even during isoproterenol infusion. AFl was successfully ablated in all 12 patients, with a median of 4 pulses delivered at the IVC-TA isthmus. In the 3 patients in whom AFl was induced, during PCS pacing in sinus rhythm before ablation, a collision of descending and ascending wave fronts was observed at the middle lateral right atrium (LRA). This activation pattern of the LRA also was noted after unsuccessful radiofrequency applications. Noninducibility of AFl after radiofrequency applications was associated with a change of activation pattern at the LRA and with an inversion of the activation sequence of the IVC-TA isthmus (from clockwise to counterclockwise) in 9 patients when pacing from the PCS. In 2 of 3 patients, despite noninducibility of atrial flutter, ablation was pursued to obtain evidence of permanent block of conduction at the IVC-TA isthmus. Finally, a completely descending LRA wave front was observed when pacing from the PCS in all patients except one. Low LRA pacing was also performed in 4 patients and showed evidence for block in the counterclockwise direction at the isthmus. During a follow-up of 9±3 months, AFl recurred in 1 patient; this was the only patient who showed no conduction block at the isthmus after the procedure.
Conclusions Direction of impulse propagation at LRA and block of propagation at the IVC-TA isthmus during PCS and low LRA pacing appear to be of interest in predicting long-term success of AFl ablation.
Key Words: atrial flutter • catheter ablation
This article has been cited by other articles:
 |
|
 |
|
  J. E. Marine Catheter Ablation Therapy for Supraventricular Arrhythmias JAMA, December 19, 2007; 298(23): 2768 - 2778. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. Hochholzer, D. Schlittenhardt, T. Arentz, J. Stockinger, R. Weber, G. Burkle, D. Kalusche, D. Trenk, and F.-J. Neumann Platelet activation and myocardial necrosis in patients undergoing radiofrequency and cryoablation of isthmus-dependent atrial flutter Europace, July 1, 2007; 9(7): 490 - 495. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. S. Thornton and L. J. Jordaens Atrial flutter: Watch and control? Europace, January 1, 2005; 7(5): 413 - 414. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Scavee, P. Jais, L.-F. Hsu, P. Sanders, M. Hocini, R. Weerasooriya, L. Macle, F. Raybaud, J. Clementy, and M. Haissaguerre Prospective randomised comparison of irrigated-tip and large-tip catheter ablation of cavotricuspid isthmus-dependent atrial flutter Eur. Heart J., June 1, 2004; 25(11): 963 - 969. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Zhang, G. Younis, R. Hariharan, J. Ho, Y. Yang, J. Ip, R. K. Thakur, J. Seger, M. M. Scheinman, and J. Cheng Lower Loop Reentry as a Mechanism of Clockwise Right Atrial Flutter Circulation, April 6, 2004; 109(13): 1630 - 1635. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Scaglione, D. Caponi, P. Di Donna, R. Riccardi, M. Bocchiardo, G. Azzaro, S. Leuzzi, and F. Gaita Typical atrial flutter ablation outcome: correlation with isthmus anatomy using intracardiac echo 3D reconstruction Europace, January 1, 2004; 6(5): 407 - 417. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E Bertaglia, F Zoppo, A Bonso, A Proclemer, R Verlato, L Coro, R Mantovan, D D'Este, F Zerbo, and P Pascotto Long term follow up of radiofrequency catheter ablation of atrial flutter: clinical course and predictors of atrial fibrillation occurrence Heart, January 1, 2004; 90(1): 59 - 63. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Andronache, C. de Chillou, H. Miljoen, I. Magnin-Poull, M. Messier, P. Dotto, D. Beurrier, T. Doan, P. Houriez, A. Bineau-Jorisse, et al. Correlation between electrogram morphology and standard criteria to validate bidirectional cavotricuspid block in common atrial flutter ablation Europace, January 1, 2003; 5(4): 335 - 341. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. J.J. Wellens Contemporary Management of Atrial Flutter Circulation, August 6, 2002; 106(6): 649 - 652. [Full Text] [PDF]
|
|
|
|
|
|
P. D. Bella, A. Fraticelli, C. Tondo, S. Riva, G. Fassini, and C. Carbucicchio Atypical atrial flutter: clinical features, electrophysiological characteristics and response to radiofrequency catheter ablation Europace, January 1, 2002; 4(3): 241 - 253. [Abstract] [PDF]
|
|
|
|
|
|
J. Chen, C. de Chillou, O-J. Ohm, P. I. Hoff, O. Rossvoll, M. Andronache, N. Sadoul, I. Magnin-Poull, K. S. Erga, and E. Aliot Acute resumption of conduction in the cavotricuspid isthmus after catheter ablation in patients with common atrial flutter: Real-time evaluation and long-term follow-up Europace, January 1, 2002; 4(3): 255 - 263. [Abstract] [PDF]
|
|
|
|
|
|
S. G. Spitzer, L. Karolyi, C. Rammler, and T. Otto Primary closed cooled tip ablation of typical atrial flutter in comparison to conventional radiofrequency ablation Europace, January 1, 2002; 4(3): 265 - 271. [Abstract] [PDF]
|
|
|
|
|
|
P A O'Callaghan, M Meara, E Kongsgaard, J Poloniecki, L Luddington, J Foran, A J Camm, E Rowland, and D E Ward Symptomatic improvement after radiofrequency catheter ablation for typical atrial flutter Heart, August 1, 2001; 86(2): 167 - 171. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N Saoudi, F Cosio, A Waldo, S.A Chen, Y Iesaka, M Lesh, S Saksena, J Salerno, and W Schoels A classification of atrial flutter and regular atrial tachycardia according to electrophysiological mechanisms and anatomical bases. A Statement from a Joint Expert Group from the Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology Eur. Heart J., July 2, 2001; 22(14): 1162 - 1182. [PDF]
|
|
|
|
 |
|
 G. Stabile, A. De Simone, P. Turco, V. La Rocca, P. Nocerino, C. Astarita, F. Maresca, C. De Matteis, T. Di Napoli, E. Stabile, et al. Response to flecainide infusion predicts long-term success of hybrid pharmacologic and ablation therapy in patients with atrial fibrillation J. Am. Coll. Cardiol., May 1, 2001; 37(6): 1639 - 1644. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Reithmann, E. Hoffmann, U. Dorwarth, T. Remp, and G. Steinbeck Electroanatomical mapping for visualization of atrial activation in patients with incisional atrial tachycardias Eur. Heart J., February 1, 2001; 22(3): 237 - 246. [Abstract] [PDF]
|
|
|
|
|
|
D. Klug, D. Lacroix, C. Marquie, G. Mairesse, D. Alix, S. Dennetiere, B. d'Hautefeuille, N. Zghal, and S. Kacet Prospective evaluation of a simplified approach for common atrial flutter radio frequency ablation with only two catheters Europace, January 1, 2001; 3(3): 208 - 215. [Abstract] [PDF]
|
|
|
|
|
|
N. Fragakis, A. Kotsakis, N. Patel, J. Bostock, E. Rosenthal, P. Holt, C. Bucknall, and J. Gill Atrial flutter ablation: Efficacy and cost-effectiveness of a single decapolar electrode to demonstrate bidirectional isthmus block Europace, January 1, 2001; 3(4): 304 - 310. [Abstract] [PDF]
|
|
|
|
|
|
J. Villacastin, J. Almendral, A. Arenal, N. P. Castellano, S. Gonzalez, M. Ortiz, J. Garcia, B. Vallbona, J. Moreno, J. F. Portales, et al. Usefulness of Unipolar Electrograms to Detect Isthmus Block After Radiofrequency Ablation of Typical Atrial Flutter Circulation, December 19, 2000; 102(25): 3080 - 3085. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Kottkamp, B. Hugl, B. Krauss, U. Wetzel, A. Fleck, G. Schuler, and G. Hindricks Electromagnetic Versus Fluoroscopic Mapping of the Inferior Isthmus for Ablation of Typical Atrial Flutter : A Prospective Randomized Study Circulation, October 24, 2000; 102(17): 2082 - 2086. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Shah, M. Haissaguerre, A. Takahashi, P. Jais, M. Hocini, and J. Clementy Differential Pacing for Distinguishing Block From Persistent Conduction Through an Ablation Line Circulation, September 26, 2000; 102(13): 1517 - 1522. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Natale, K. H. Newby, E. Pisano, F. Leonelli, R. Fanelli, D. Potenza, S. Beheiry, and G. Tomassoni Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter J. Am. Coll. Cardiol., June 1, 2000; 35(7): 1898 - 1904. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Heidbuchel, R. Willems, H. van Rensburg, J. Adams, H. Ector, and F. Van de Werf Right Atrial Angiographic Evaluation of the Posterior Isthmus : Relevance for Ablation of Typical Atrial Flutter Circulation, May 9, 2000; 101(18): 2178 - 2184. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. C. Shah, A. Takahashi, P. Jais, M. Hocini, J. Tian Peng, J. Clementy, and M. Haissaguerre Tracking dynamic conduction recovery across the cavotricuspid isthmus J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1478 - 1484. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C Reithmann, E Hoffmann, G Spitzlberger, U Dorwarth, A Gerth, T Remp, and G Steinbeck Catheter ablation of atrial flutter due to amiodarone therapy for paroxysmal atrial fibrillation Eur. Heart J., April 1, 2000; 21(7): 565 - 572. [Abstract] [PDF]
|
|
|
|
|
|
P. Jais, D. C. Shah, M. Haissaguerre, M. Hocini, S. Garrigue, P. Le Metayer, and J. Clementy Prospective Randomized Comparison of Irrigated-Tip Versus Conventional-Tip Catheters for Ablation of Common Flutter Circulation, February 22, 2000; 101(7): 772 - 776. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. G. Kall, D. S. Rubenstein, D. E. Kopp, M. C. Burke, R. J. Verdino, A. C. Lin, C. T. Johnson, P. A. Cooke, Z. G. Wang, M. Fumo, et al. Atypical Atrial Flutter Originating in the Right Atrial Free Wall Circulation, January 25, 2000; 101(3): 270 - 279. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Iesaka, T. Yamane, M. Goya, A. Takahashi, H. Fujiwara, Y. Okamoto, Y. Soejima, J. Nitta, A. Nogami, K. Aonuma, et al. A jump in cycle length of orthodromic common atrial flutter during catheter ablation at the isthmus between the inferior vena cava and tricuspid annulus: Evidence of dual isthmus conduction directed to dual septal exits Europace, January 1, 2000; 2(2): 163 - 171. [Abstract] [PDF]
|
|
|
|
|
|
F. G. Cosio, A. Pastor, A. Nunez, and M. A. Montero How to map and ablate atrial scar macroreentrant tachycardia of the right atrium Europace, January 1, 2000; 2(3): 193 - 200. [Abstract] [PDF]
|
|
|
|
|
|
C.-F. Tsai, C.-T. Tai, W.-C. Yu, Y.-J. Chen, M.-H. Hsieh, C.-E. Chiang, Y.-A. Ding, M.-S. Chang, and S.-A. Chen Is 8-mm More Effective Than 4-mm Tip Electrode Catheter for Ablation of Typical Atrial Flutter? Circulation, August 17, 1999; 100(7): 768 - 771. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Nabar, L.-M. Rodriguez, C. Timmermans, J. L. R. M. Smeets, and H. J. J. Wellens Isoproterenol to Evaluate Resumption of Conduction After Right Atrial Isthmus Ablation in Type I Atrial Flutter Circulation, June 29, 1999; 99(25): 3286 - 3291. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Arenal, J. Almendral, J. M. Alday, J. Villacastin, J. M. Ormaetxe, J. L. M. Sande, N. Perez-Castellano, S. Gonzalez, M. Ortiz, and J. L. Delcan Rate-Dependent Conduction Block of the Crista Terminalis in Patients With Typical Atrial Flutter : Influence on Evaluation of Cavotricuspid Isthmus Conduction Block Circulation, June 1, 1999; 99(21): 2771 - 2778. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Nabar, L.-M. Rodriguez, C. Timmermans, A. van den Dool, J. L. R. M. Smeets, and H. J. J. Wellens Effect of Right Atrial Isthmus Ablation on the Occurrence of Atrial Fibrillation : Observations in Four Patient Groups Having Type I Atrial Flutter With or Without Associated Atrial Fibrillation Circulation, March 23, 1999; 99(11): 1441 - 1445. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Anselme, N. Saoudi, H. Poty, R. Douillet, and A. Cribier Radiofrequency Catheter Ablation of Common Atrial Flutter : Significance of Palpitations and Quality-of-Life Evaluation in Patients With Proven Isthmus Block Circulation, February 2, 1999; 99(4): 534 - 540. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Shah, M. Haissaguerre, P. Jais, A. Takahashi, M. Hocini, and J. Clementy High-Density Mapping of Activation Through an Incomplete Isthmus Ablation Line Circulation, January 19, 1999; 99(2): 211 - 215. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Yamabe, K. Okumura, I. Misumi, H. Fukushima, K. Ueno, Y. Kimura, and Y. Hokamura Role of bipolar electrogram polarity mapping in localizing recurrent conduction in the isthmus early and late after ablation of atrial flutter J. Am. Coll. Cardiol., January 1, 1999; 33(1): 39 - 45. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Takahashi, D.C. Shah, P. Jais, and M. Haissaguerre How to ablate typical atrial flutter Europace, January 1, 1999; 1(3): 151 - 155. [PDF]
|
|
|
|
|
|
J-L Lin, L-P Lai, L-J Lin, Y-Z Tseng, W-P Lien, and S K S Huang Electrophysiological determinant for induction of isthmus dependent counterclockwise and clockwise atrial flutter in humans Heart, January 1, 1999; 81(1): 73 - 81. [Abstract] [Full Text]
|
|
|
|
|
|
L. M. Epstein, M. A. Mitchell, T. W. Smith, and D. E. Haines Comparative Study of Fluoroscopy and Intracardiac Echocardiographic Guidance for the Creation of Linear Atrial Lesions Circulation, October 27, 1998; 98(17): 1796 - 1801. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Saoudi, M. Redonnet, F. Anselme, H. Poty, and A. Cribier Catheter ablation of atrioatrial conduction as a cure for atrial arrhythmia after orthotopic heart transplantation J. Am. Coll. Cardiol., October 1, 1998; 32(4): 1048 - 1055. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Jais, M. Haissaguerre, D. C. Shah, A. Takahashi, M. Hocini, T. Lavergne, S. Lafitte, A. Le Mouroux, B. Fischer, and J. Clementy Successful Irrigated-Tip Catheter Ablation of Atrial Flutter Resistant to Conventional Radiofrequency Ablation Circulation, September 1, 1998; 98(9): 835 - 838. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Paydak, J. G. Kall, M. C. Burke, D. Rubenstein, D. E. Kopp, R. J. Verdino, and D. J. Wilber Atrial Fibrillation After Radiofrequency Ablation of Type I Atrial Flutter : Time to Onset, Determinants, and Clinical Course Circulation, July 28, 1998; 98(4): 315 - 322. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. C. Shah, P. Jais, M. Haissaguerre, S. Chouairi, A. Takahashi, M. Hocini, S. Garrigue, and J. Clementy Three-dimensional Mapping of the Common Atrial Flutter Circuit in the Right Atrium Circulation, December 2, 1997; 96(11): 3904 - 3912. [Abstract] [Full Text]
|
|
|
|
|
|
D. C. Shah, M. Haissaguerre, P. Jais, B. Fischer, A. Takahashi, M. Hocini, and J. Clementy Simplified Electrophysiologically Directed Catheter Ablation of Recurrent Common Atrial Flutter Circulation, October 21, 1997; 96(8): 2505 - 2508. [Abstract] [Full Text]
|
|
|
|
|
|
C.-T. Tai, S.-A. Chen, C.-E. Chiang, S.-H. Lee, K.-C. Ueng, Z.-C. Wen, J.-L. Huang, Y.-J. Chen, W.-C. Yu, A.-N. Feng, et al. Characterization of Low Right Atrial Isthmus as the Slow Conduction Zone and Pharmacological Target in Typical Atrial Flutter Circulation, October 21, 1997; 96(8): 2601 - 2611. [Abstract] [Full Text]
|
|
|
|
|
|
H. Poty, N. Saoudi, M. Nair, F. Anselme, and B. Letac Radiofrequency Catheter Ablation of Atrial Flutter: Further Insights Into the Various Types of Isthmus Block: Application to Ablation During Sinus Rhythm Circulation, December 15, 1996; 94(12): 3204 - 3213. [Abstract] [Full Text]
|
|
|
|
|
|
G. F. Van Hare and A. L. Waldo The Atrial Flutter Reentrant Circuit: Additional Pieces of the Puzzle Circulation, August 1, 1996; 94(3): 244 - 246. [Full Text]
|
|
|
|
|
|
J. M. Kalman, J. E. Olgin, L. A. Saxon, W. G. Fisher, R. J. Lee, and M. D. Lesh Activation and Entrainment Mapping Defines the Tricuspid Annulus as the Anterior Barrier in Typical Atrial Flutter Circulation, August 1, 1996; 94(3): 398 - 406. [Abstract] [Full Text]
|
|
|
|
 |
|
 Catheter Ablation of Atrial Flutter Journal Watch Cardiology, November 1, 1995; 1995(1101): 16 - 16. [Full Text]
|
|
|
|
 |
|
 CATHETER ABLATION OF ATRIAL FLUTTER Journal Watch (General), September 26, 1995; 1995(926): 5 - 5. [Full Text]
|
|