Advertisement

Pathophysiology of Atypical Atrial Flutters

Published:August 24, 2022DOI:https://doi.org/10.1016/j.ccep.2022.03.002

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Cardiac Electrophysiology Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bun S.S.
        • Latcu D.G.
        • Marchlinski F.
        • et al.
        Atrial flutter: more than just one of a kind.
        Eur Heart J. 2015; 36: 2356-2363
        • Saoudi N.
        • Chairman M.D.
        • Cosio F.
        • et al.
        Classification of atrial flutter and regular atrial tachycardia according to electrophysiologic mechanism and anatomic bases: a statement from a Joint Expert Group from the Working Group of Arrhythmias of the European Society of Cardiology and the North A.
        J Cardiovasc Electrophysiol. 2001; 12: 852-866
        • Nakagawa H.
        • Shah N.
        • Matsudaira K.
        • et al.
        Characterization of reentrant circuit in macroreentrant right atrial tachycardia after surgical repair of congenital heart disease.
        Circulation. 2001; 103: 699-709
        • Kall J.G.
        • Rubenstein D.S.
        • Kopp D.E.
        • et al.
        Atypical atrial flutter originating in the right atrial free wall.
        Circulation. 2000; 101: 270-279
        • Jaïs P.
        • Shah D.C.
        • Haïssaguerre M.
        • et al.
        Mapping and ablation of left atrial flutters.
        Circulation. 2000; 101: 2928-2934
        • Ouyang F.
        • Ernst S.
        • Vogtmann T.
        • et al.
        Characterization of reentrant circuits in left atrial macroreentrant tachycardia: critical isthmus block can prevent atrial tachycardia recurrence.
        Circulation. 2002; 105: 1934-1942
        • Kalman J.M.
        • VanHare G.F.
        • Olgin J.E.
        • et al.
        Ablation of ‘incisional’ reentrant atrial tachycardia complicating surgery for congenital heart disease.
        Circulation. 1996; 93: 502-512
        • Deisenhofer I.
        • Estner H.
        • Zrenner B.
        • et al.
        Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation: incidence, electrophysiological characteristics, and results of radiofrequency ablation.
        Europace. 2006; 8: 573-582
        • Tai C.T.
        • Huang J.L.
        • Lin Y.K.
        • et al.
        Noncontact three-dimensional mapping and ablation of upper loop re-entry originating in the right atrium.
        J Am Coll Cardiol. 2002; 40: 746-753
        • Marrouche N.F.
        • Natale A.
        • Wazni O.M.
        • et al.
        Left septal atrial flutter: electrophysiology, anatomy, and results of ablation.
        Circulation. 2004; 109: 2440-2447
        • Natale A.
        • Newby K.H.
        • Pisanó E.
        • et al.
        Prospective randomized comparison of antiarrhythmic therapy versus first- line radiofrequency ablation in patients with atrial flutter.
        J Am Coll Cardiol. 2000; 35: 1898-1904
        • Marazzato J.
        • Cappabianca G.
        • Angeli F.
        • et al.
        Ablation of atrial tachycardia in the setting of prior mitral valve surgery.
        Minerva Cardiol Angiol. 2021; 69: 94-101
        • Marazzato J.
        • Cappabianca G.
        • Angeli F.
        • et al.
        Catheter ablation of atrial tachycardias after mitral valve surgery: a systematic review and meta-analysis.
        J Cardiovasc Electrophysiol. 2020; 31: 2632-2641
        • Markowitz S.M.
        • Brodman R.F.
        • Stein K.M.
        • et al.
        Lesional tachycardias related to mitral valve surgery.
        J Am Coll Cardiol. 2002; 39: 1973-1983
        • Gopinathannair R.
        • Mar P.L.
        • Afzal M.R.
        • et al.
        Atrial tachycardias after surgical atrial fibrillation ablation: clinical characteristics, electrophysiological mechanisms, and ablation outcomes from a large, multicenter study.
        JACC Clin Electrophysiol. 2017; 3: 865-874
        • Morady F.
        • Oral H.
        • Chugh A.
        Diagnosis and ablation of atypical atrial tachycardia and flutter complicating atrial fibrillation ablation.
        Hear Rhythm. 2009; 6: S29-S32
        • Akerström F.
        • Bastani H.
        • Insulander P.
        • et al.
        Comparison of regular atrial tachycardia incidence after circumferential radiofrequency versus cryoballoon pulmonary vein isolation in real-life practice.
        J Cardiovasc Electrophysiol. 2014; 25: 948-952
        • Ciconte G.
        • Baltogiannis G.
        • De Asmundis C.
        • et al.
        Circumferential pulmonary vein isolation as index procedure for persistent atrial fibrillation: a comparison between radiofrequency catheter ablation and second-generation cryoballoon ablation.
        Europace. 2015; 17: 559-565
        • Wasmer K.
        • Mönnig G.
        • Bittner A.
        • et al.
        Incidence, characteristics, and outcome of left atrial tachycardias after circumferential antral ablation of atrial fibrillation.
        Hear Rhythm. 2012; 9: 1660-1666
        • Pappone C.
        • Oreto G.
        • Rosanio S.
        • et al.
        Atrial Electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation.
        Circulation. 2001; 104: 2539-2544
        • Jaïs P.
        • Sanders P.
        • Hsu L.F.
        • et al.
        Flutter localized to the anterior left atrium after catheter ablation of atrial fibrillation.
        J Cardiovasc Electrophysiol. 2006; 17: 279-285
        • Zhou G.B.
        • Hu J.Q.
        • Guo X.G.
        • et al.
        Very long-term outcome of catheter ablation of post-incisional atrial tachycardia: role of incisional and non-incisional scar.
        Int J Cardiol. 2016; 205: 72-80
        • John B.
        • Stiles M.K.
        • Kuklik P.
        • et al.
        Electrical remodelling of the left and right atria due to rheumatic mitral stenosis.
        Eur Heart J. 2008; 29: 2234-2243
        • Fiala M.
        • Chovančík J.
        • Neuwirth R.
        • et al.
        Atrial macroreentry tachycardia in patients without obvious structural heart disease or previous cardiac surgical or catheter intervention: characterization of arrhythmogenic substrates, reentry circuits, and results of catheter ablation.
        J Cardiovasc Electrophysiol. 2007; 18: 824-832
        • Stevenson I.H.
        • Kistler P.M.
        • Spence S.J.
        • et al.
        Scar-related right atrial macroreentrant tachycardia in patients without prior atrial surgery: electroanatomic characterization and ablation outcome.
        Hear Rhythm. 2005; 2: 594-601
        • Kharbanda R.K.
        • Özdemir E.H.
        • Taverne Y.J.H.J.
        • et al.
        Current Concepts of anatomy, electrophysiology, and therapeutic implications of the interatrial septum.
        JACC Clin Electrophysiol. 2019; 5: 647-656
        • Melby S.J.
        • Lee A.M.
        • Zierer A.
        • et al.
        Atrial fibrillation propagates through gaps in ablation lines: implications for ablative treatment of atrial fibrillation.
        Hear Rhythm. 2008; 5: 1296-1301
        • De Ponti R.
        • Marazzi R.
        • Zoli L.
        • et al.
        Electroanatomic mapping and ablation of macroreentrant atrial tachycardia: comparison between successfully and unsuccessfully treated cases.
        J Cardiovasc Electrophysiol. 2010; 21: 155-162
        • De Ponti R.
        • Verlato R.
        • Bertaglia E.
        • et al.
        Treatment of macro-re-entrant atrial tachycardia based on electroanatomic mapping: identification and ablation of the mid-diastolic isthmus.
        Europace. 2007; 9: 449-457
        • Allessie M.A.
        • Bonke F.I.M.
        • Schopman F.J.G.
        Circus movement in rabbit atrial muscle as a mechanism of tachycardia. II. The role of nonuniform recovery of excitability in the occurrence of unidirectional block, as studied with multiple microelectrodes.
        Circ Res. 1976; 39: 168-177
        • Bogun F.
        • Bender B.
        • Li Y.G.
        • et al.
        Ablation of atypical atrial flutter guided by the use of concealed entrainment in patients without prior cardiac surgery.
        J Cardiovasc Electrophysiol. 2000; 11: 136-145
        • Sanders P.
        • Hocini M.
        • Jaïs P.
        • et al.
        Characterization of focal atrial tachycardia using high-density mapping.
        J Am Coll Cardiol. 2005; 46: 2088-2099
        • Jaïs P.
        • Matsuo S.
        • Knecht S.
        • et al.
        A deductive mapping strategy for atrial tachycardia following atrial fibrillation ablation: importance of localized reentry.
        J Cardiovasc Electrophysiol. 2009; 20: 480-491
        • Luther V.
        • Sikkel M.
        • Bennett N.
        • et al.
        Visualizing localized reentry with ultra-high density mapping in iatrogenic atrial tachycardia.
        Circ Arrhythmia Electrophysiol. 2017; 10: e004724
        • Frontera A.
        • Mahajan R.
        • Dallet C.
        • et al.
        Characterizing localized reentry with high-resolution mapping: evidence for multiple slow conducting isthmuses within the circuit.
        Hear Rhythm. 2019; 16: 679-685
        • De Groot N.M.S.
        • Schalij M.J.
        Fragmented, long-duration, low-amplitude electrograms characterize the origin of focal atrial tachycardia.
        J Cardiovasc Electrophysiol. 2006; 17: 1086-1092
        • Markowitz S.M.
        • Nemirovksy D.
        • Stein K.M.
        • et al.
        Adenosine-insensitive focal atrial tachycardia. evidence for de novo micro-re-entry in the human atrium.
        J Am Coll Cardiol. 2007; 49: 1324-1333
        • Liu C.F.
        • Cheung J.W.
        • Ip J.E.
        • et al.
        Unifying algorithm for mechanistic diagnosis of atrial tachycardia.
        Circ Arrhythmia Electrophysiol. 2016; 9: e004028
        • Okumura K.
        • Plumb V.J.
        • Pagé P.L.
        • et al.
        Atrial activation sequence during atrial flutter in the canine pericarditis model and its effects on the polarity of the flutter wave in the electrocardiogram.
        J Am Coll Cardiol. 1991; 17: 509-518
        • Ndrepepa G.
        • Zrenner B.
        • Deisenhofer I.
        • et al.
        Relationship between surface electrocardiogram characteristics and endocardial activation sequence in patients with typical atrial flutter.
        Z Kardiol. 2000; 89: 527-537
        • Ndrepepa G.
        • Zrenner B.
        • Weyerbrock S.
        • et al.
        Activation patterns in the left atrium during counterclockwise and clockwise atrial flutter.
        J Cardiovasc Electrophysiol. 2001; 12: 893-899
        • Barbato G.
        • Carinci V.
        • Tomasi C.
        • et al.
        Is electrocardiography a reliable tool for identifying patients with isthmus-dependent atrial flutter?.
        Europace. 2009; 11: 1071-1076
        • Zrenner B.
        • Ndrepepa G.
        • Karch M.
        • et al.
        Block of the lower interatrial connections: insight into the sources of electrocardiographic diversities in common type atrial flutter.
        Pacing Clin Electrophysiol. 2000; 23: 917-920
        • Akar J.G.
        • Al-Chekakie M.O.
        • Hai A.
        • et al.
        Surface electrocardiographic patterns and electrophysiologic characteristics of atrial flutter following modified radiofrequency MAZE procedures.
        J Cardiovasc Electrophysiol. 2007; 18: 349-355
        • Chugh A.
        • Latchamsetty R.
        • Oral H.
        • et al.
        Characteristics of cavotricuspid isthmus-dependent atrial flutter after left atrial ablation of atrial fibrillation.
        Circulation. 2006; 113: 609-615
        • Pap R.
        • Kohári M.
        • Makai A.
        • et al.
        Surgical technique and the mechanism of atrial tachycardia late after open heart surgery.
        J Interv Card Electrophysiol. 2012; 35: 127-135
        • Roten L.
        • Lukac P.
        • De Groot N.
        • et al.
        Catheter ablation of arrhythmias in Ebstein’s anomaly: a multicenter study.
        J Cardiovasc Electrophysiol. 2011; 22: 1391-1396
        • Yap S.C.
        • Harris L.
        • Silversides C.K.
        • et al.
        Outcome of intra-atrial re-entrant tachycardia catheter ablation in adults with congenital heart disease: negative impact of age and complex atrial surgery.
        J Am Coll Cardiol. 2010; 56: 1589-1596
        • Collins K.K.
        • Love B.A.
        • Walsh E.P.
        • et al.
        Location of acutely successful radiofrequency catheter ablation of intraatrial reentrant tachycardia in patients with congenital heart disease.
        Am J Cardiol. 2000; 86: 969-974
        • Chae S.
        • Oral H.
        • Good E.
        • 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. 2007; 50: 1781-1787
        • Mönnig G.
        • Wasmer K.
        • Milberg P.
        • et al.
        Predictors of long-term success after catheter ablation of atriofascicular accessory pathways.
        Hear Rhythm. 2012; 9: 704-708
        • Lyan E.
        • Yalin K.
        • Abdin A.
        • et al.
        Mechanism, underlying substrate and predictors of atrial tachycardia following atrial fibrillation ablation using the second-generation cryoballoon.
        J Cardiol. 2019; 73: 497-506
        • Schaeffer B.
        • Akbulak R.
        • Jularic M.
        • et al.
        High-density mapping and ablation of primary nonfocal left atrial tachycardia: characterizing a distinct arrhythmogenic substrate.
        JACC Clin Electrophysiol. 2019; 5: 417-426
        • Röcken C.
        • Peters B.
        • Juenemann G.
        • et al.
        Atrial amyloidosis: an arrhythmogenic substrate for persistent atrial fibrillation.
        Circulation. 2002; 106: 2091-2097