(Circulation. 1999;99:3017-3023.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Angiographic Anatomy of the Inferior Right Atrial Isthmus in Patients With and Without History of Common Atrial Flutter
From Pino Hospital, University of Las Palmas (J.A.C., A.M., F.W., E.G., J.G., E.H.), Canary Island, Spain; Facultad de Medicina, Universidad de Extremadura (D.S.-Q.), Badajoz, Spain; and Paediatrics, Imperial College School of Medicine at National Heart and Lung Institute (S.Y.H., R.H.A.), London, UK.
Correspondence to Dr S.Y. Ho, National Heart and Lung Institute, Imperial College School of Medicine, Dovehouse St, London SW3 6LY, UK. E-mail yen.ho{at}ic.ac.uk
Background—Although most ablative procedures undertaken for common atrial flutter target the inferior right atrial isthmus, comparative studies of the morphology of this area are lacking. Our study examines its angiographic anatomy, making correlations with postmortem specimens, to provide a better understanding of the anatomic substrate of this arrhythmia.
Methods and Results—The gross morphological features and dimensions of the area between the orifice of the inferior caval vein and the attachment of the septal leaflet of the tricuspid valve were determined from angiograms made in 23 patients with documented atrial flutter and 30 control subjects. For comparison, we studied 20 normal heart specimens. When viewed in right anterior oblique projection, 2 morphologically distinct areas were identified. In the specimens, the inferior isthmus measured a mean length of 30±4 mm, not significantly different from the dimensions obtained from angiograms of control subjects. The mean length of the isthmus, however, was greater in patients with common atrial flutter than those without (37±8 versus 28±6 mm). Patients with atrial flutter and structural heart disease had an even longer isthmus than those with flutter alone (39.6±8 versus 33±7 mm). Compared with those without flutter, the atrial diameter was also larger in patients with flutter (57.6±9 versus 48.5±6 mm). Reevaluation carried out at follow-up 10±2 months after ablation did not show any reduction in atrial size, although contractility improved.
Conclusions—The inferior isthmus and right atrium in patients with common atrial flutter were significantly larger than those in a control population.
Key Words: atrial flutter • atrium • angiography • catheter ablation
This article has been cited by other articles:
 |
|
 |
|
  F. Saremi, L. Pourzand, S. Krishnan, O. Ashikyan, S. V. Gurudevan, J. Narula, K. Kaushal, and A. Raney Right Atrial Cavotricuspid Isthmus: Anatomic Characterization with Multi-Detector Row CT Radiology, June 1, 2008; 247(3): 658 - 668. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Saremi and S. Krishnan Cardiac Conduction System: Anatomic Landmarks Relevant to Interventional Electrophysiologic Techniques Demonstrated with 64-Detector CT RadioGraphics, November 1, 2007; 27(6): 1539 - 1565. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Da Costa, C. Romeyer-Bouchard, V. Dauphinot, D. Lipp, L. Abdellaoui, M. Messier, J. Thevenin, J.-C. Barthelemy, and K. Isaaz Cavotricuspid isthmus angiography predicts atrial flutter ablation efficacy in 281 patients randomized between 8 mm- and externally irrigated-tip catheter Eur. Heart J., August 1, 2006; 27(15): 1833 - 1840. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Zanchetta, G. Rigatelli, and S. Y. Ho A Mystery Featuring Right-to-Left Shunting Despite Normal Intracardiac Pressure Chest, August 1, 2005; 128(2): 998 - 1002. [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]
|
|
|
|
 |
|
 A. Da Costa, E. Faure, J. Thevenin, M. Messier, S. Bernard, K. Abdel, C. Robin, C. Romeyer, and K. Isaaz Effect of Isthmus Anatomy and Ablation Catheter on Radiofrequency Catheter Ablation of the Cavotricuspid Isthmus Circulation, August 31, 2004; 110(9): 1030 - 1035. [Abstract] [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]
|
|
|
|
 |
|
 F G Cosio The right atrium as an anatomic set-up for re-entry: electrophysiology goes back to anatomy Heart, October 1, 2002; 88(4): 325 - 327. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Y. Ho, R. H. Anderson, and D. Sanchez-Quintana Atrial structure and fibres: morphologic bases of atrial conduction Cardiovasc Res, May 1, 2002; 54(2): 325 - 336. [Abstract] [Full Text] [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]
|
|
|
|
|
|
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]
|
|