Characterization of the anatomy and conduction velocities of the human right atrial flutter circuit determined by noncontact mapping.

OBJECTIVES This study was done to characterize human right atrial (RA) flutter (AFL) using noncontact mapping. BACKGROUND Atrial flutter has been mapped using sequential techniques, but complex anatomy makes simultaneous global RA mapping difficult. METHODS Noncontact mapping was used to map the RA of 13 patients with AFL (5 with previous attempts), 11 with counterclockwise and 2 with clockwise AFL. "Reconstructed" electrograms were validated against contact electrograms using cross-correlation. The Cartesian coordinates of points on a virtual endocardium were used to calculate the length and thus the conduction velocity (CV) of the AFL wave front within the tricuspid annulus-inferior vena cave isthmus (IS) and either side of the crista terminalis (CT). RESULTS When clearly seen, the AFL wave front split (n = 3) or turned in the region of the coronary sinus os (n = 6). Activation progressed toward the tricuspid annulus (TA) from the surrounding RA in 10 patients, suggesting that the leading edge of the reentry wave front is not always at the TA. The IS length and CV was 47.73 +/- 24.40 mm (mean +/- SD) and 0.74 +/- 0.36 m/s. The CV was similar for the smooth and trabeculated RA (1.16 +/- 0.48 m/s and 1.22 +/- 0.65 m/s, respectively [p = 0.67]) and faster than the IS (p = 0.03 and p = 0.05 for smooth and trabeculated, respectively). CONCLUSIONS Noncontact mapping of AFL has been validated and has demonstrated that IS CV is significantly slower than either side of the CT.

[1]  F. Cosío,et al.  Mechanisms of entrainment of human common flutter studied with multiple endocardial recordings. , 1994, Circulation.

[2]  D. K. Racker.  Atrioventricular node and input pathways: A correlated gross anatomical and histological study of the canine atrioventricular junctional region , 1989, The Anatomical record.

[3]  F. Cosío,et al.  Radiofrequency ablation of the inferior vena cava-tricuspid valve isthmus in common atrial flutter. , 1993, The American journal of cardiology.

[4]  A. Kadish,et al.  Endocardial mapping of atrial fibrillation in the human right atrium using a non-contact catheter. , 2000, European heart journal.

[5]  N. Peters,et al.  Simultaneous endocardial mapping in the human left ventricle using a noncontact catheter: comparison of contact and reconstructed electrograms during sinus rhythm. , 1998, Circulation.

[6]  Rate-dependent conduction block of the crista terminalis in patients with typical atrial flutter: influence on evaluation of cavotricuspid isthmus conduction block. , 1999, Circulation.

[7]  Y. Rudy,et al.  Mechanism of Spontaneous Termination of Stable Atrial Flutter in the Canine Sterile Pericarditis Model , 1993, Circulation.

[8]  N S Peters,et al.  Characteristics of Sinus Rhythm Electrograms at Sites of Ablation of Ventricular Tachycardia Relative to All Other Sites: A Noncontact Mapping Study of the Entire Left Ventricle , 1998, Journal of cardiovascular electrophysiology.

[9]  M. Scheinman,et al.  Acceleration of typical atrial flutter due to double-wave reentry induced by programmed electrical stimulation. , 1998, Circulation.

[10]  M. Burke,et al.  Conduction Properties of the Inferior Vena Cava‐Tricuspid Annular Isthmus in Patients with Typical Atrial Flutter , 1997, Journal of cardiovascular electrophysiology.

[11]  J. Camm,et al.  Geometrically accurate activation mapping of the atrioventricular node region during surgery. , 1992, Journal of the American College of Cardiology.

[12]  J. L. Huang,et al.  Characterization of low right atrial isthmus as the slow conduction zone and pharmacological target in typical atrial flutter. , 1997, Circulation.

[13]  J. Olgin,et al.  Electrocardiographic and Electrophysiologic Characterization of Atypical Atrial Flutter in Man: , 1997, Journal of cardiovascular electrophysiology.

[14]  J. Olgin,et al.  Role of right atrial endocardial structures as barriers to conduction during human type I atrial flutter. Activation and entrainment mapping guided by intracardiac echocardiography. , 1995, Circulation.

[15]  A. Iwasa,et al.  The upper turnover site in the reentry circuit of common atrial flutter. , 1996, The American journal of cardiology.

[16]  D. Shah,et al.  Three-dimensional mapping of the common atrial flutter circuit in the right atrium. , 1997, Circulation.

[17]  M. Scheinman,et al.  Right atrial flutter due to lower loop reentry: mechanism and anatomic substrates. , 1999, Circulation.

[18]  A L Waldo,et al.  Characterization of double potentials in human atrial flutter: studies during transient entrainment. , 1990, Journal of the American College of Cardiology.

[19]  J. Olgin,et al.  Activation and entrainment mapping defines the tricuspid annulus as the anterior barrier in typical atrial flutter. , 1996, Circulation.

[20]  F. Cosío,et al.  Living anatomy of the atrioventricular junctions. A guide to electrophysiologic mapping. A Consensus Statement from the Cardiac Nomenclature Study Group, Working Group of Arrhythmias, European Society of Cardiology, and the Task Force on Cardiac Nomenclature from NASPE. , 1999, Circulation.

[21]  B F Hoffman,et al.  Anatomy of the Tricuspid Annulus Circumferential Myofibers as the Structural Basis for Atrial Flutter in a Canine Model , 1991, Circulation.

[22]  N S Peters,et al.  Feasibility of a noncontact catheter for endocardial mapping of human ventricular tachycardia. , 1999, Circulation.

[23]  F. Cosío,et al.  Validation of double-spike electrograms as markers of conduction delay or block in atrial flutter. , 1988, The American journal of cardiology.

[24]  F. Cosío,et al.  Electrophysiologic studies in atrial flutter , 1992, Clinical cardiology.