Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Atrial Flutter”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 253 records · Page 14Linked to original sources
PubMed2000

Treatment of mixed atrial fibrillation and typical atrial flutter by hybrid catheter ablation.

Successful isthmus ablation of typical atrial flutter mixed with atrial fibrillation (AF) may favorably modify the subsequent course of paroxysmal AF. However, the source of ectopic beats triggering AF may be located in the pulmonary veins (PV). This study compared the results of combined isthmus and focal ablation with ablation limited to the isthmus in patients with mixed AF and typical atrial flutter. Thirty patients with typical atrial flutter and AF were treated. Ablation limited to the isthmus was performed in 14 patients (group A), and 16 patients underwent focal ablation of triggering ectopic beats combined with isthmus ablation (group B). Successful linear ablation of the isthmus was accomplished in all patients. In group A, AF was eliminated in 4 patients (29%) after isthmus ablation. In group B, the origin of 26 foci triggering AF (1 focus in 38% of patients, 2 foci in 31%, 3-4 foci in 31%) was found in the PV in 93% (left superior: 46% left inferior: 21%, right superior: 25%) and the right atrium in 7% of instances. AF was eliminated in 11 patients (69%) after ablation of these foci. The success rate in group B was significantly higher than in group A (P < 0.05). In conclusion, in cases of mixed AF and typical atrial flutter, episodes of AF originated from PV foci in > 90% of instances. These findings suggest that isthmus ablation combined with PV focal ablation may be effective in mixed AF and typical atrial flutter.

Atrial Fibrillation↗
PubMed2006

Chronotropic incompetence in young patients with late postoperative atrial flutter: a case-control study.

AIMS: Atrial flutter causes late postoperative morbidity in congenital heart disease (CHD). Sinoatrial node dysfunction is associated with late postoperative atrial flutter, but pacing interventions driven by minimum heart rates (HR) have yielded mixed results. METHODS AND RESULTS: A retrospective case-control study was used to test the hypothesis that late postoperative atrial flutter is associated with chronotropic incompetence in active young CHD patients. Control CHD patients aged < or =18 years without documented supraventricular ectopy (n = 42) were matched with 42 patients (cases) having atrial flutter onset > or =6 months postoperatively. Minimum, average, and maximum non-flutter HRs were obtained from outpatient ambulatory 24 h ECG (Holter) recordings and graded exercise tests. Chronotropic competence was assessed using percentage of age-specific predicted maximum HR achieved, and calculated chronotropic index. Effects of rate-adaptive programming and maximum atrial pacing rates were analysed in 19 permanently paced cases. Least square estimates of minimum HRs were similar in cases and controls (54+/-2 vs. 52+/-2 bpm). Average HRs were lower in cases (75+/-2 vs. 81+/-2 bpm, P=0.02). Cases and controls differed most significantly with respect to percentage of predicted maximum HR achieved (67+/-2 vs. 80+/-2%, P < 0.001). This difference remained highly significant when the data were adjusted for age, sex, permanent pacing, and negatively chronotropic medication usage at the time of testing. Among paced patients, atrial flutter was significantly less likely to be observed in the setting of rate-adaptive pacing [odds ratio (OR) = 0.36; P < 0.05], and the likelihood of detecting atrial flutter decreased relative to the maximum programmed atrial pacing rate (OR 0.87 for every 5% increment in maximum pacing rate relative to maximum predicted HR for age; P < 0.05). CONCLUSION: Late postoperative atrial flutter is associated with chronotropic incompetence in paediatric CHD patients.

Adolescent↗
PubMed1986

A new animal model of atrial flutter.

A new, simple and reliable model of atrial flutter utilizing postpericardiotomy pericarditis was developed in the dog. Using a sterile technique, the pericardium was opened by way of a right thoracotomy, Teflon-coated, stainless steel wire electrodes were fixed to three selected sites on the atria and exteriorized, the atrial surfaces were generously dusted with talcum powder and a single layer of gauze was placed on the free left and right atrial walls. The dogs were allowed to recover. Subsequently, the inducibility of atrial flutter and selected electrophysiologic properties of the atria were determined by daily programmed atrial stimulation studies with the dogs in the conscious, nonsedated state. Atrial flutter could be induced in 23 of 25 dogs initially studied. It was sustained (that is, lasting greater than or equal to 5 min) in 17 of the 23. Neither atrial excitability, intraatrial conduction time nor atrial refractoriness determined by pacing and recording from the three fixed sites predicted the inducibility of atrial flutter. One hundred thirty-nine episodes of atrial flutter induced in these 23 dogs were analyzed. The mean sustained atrial flutter cycle length was 131 +/- 20 ms (mean +/- SD) (range 100 to 170); the atrial flutter cycle length was 150 ms or more in 23 episodes, between 120 and 150 ms in 64 episodes and 120 ms or less in 52 episodes. In five dogs, the stability of the atrial flutter cycle length during sustained atrial flutter was studied and shown to be remarkably stable in all five until interrupted by rapid atrial pacing 35 to 95 minutes after its induction.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1996

Effects of atrial fibrillation and atrial flutter on the signal-averaged electrocardiogram.

In conclusion, atrial flutter can create significant errors in the automated time-domain analysis of the SAECG that are only apparent when the study is repeated in sinus rhythm, thus lowering the predictive accuracy of the technique in patients with atrial flutter. Atrial fibrillation rarely creates problems with time-domain analysis of the SAECG. These findings suggest that, unless the performance of a specific signal-averaging device has been evaluated in patients with atrial flutter and found to have acceptable error rates, patients with atrial flutter should not have SAECGs performed for postinfarction risk assessment.

Adult↗
PubMed2001

[Atrial flutter--diagnosis and therapeutic possibilities].

BACKGROUND: Atrial flutter and atrial fibrillation are among the most common heart rhythm disturbances in the population, with an assumed prevalence of 1-2%. About 40,000-60,000 Norwegians endure such rhythm disorders, with an increasing occurrence in the elderly population. MATERIAL AND METHODS: Surface ECG remains the corner-stone for the clinical diagnosis. We describe the various mechanisms, clinical presentation, and diagnosis based on modern invasive electrophysiological methods of atrial flutter. RESULTS: The available therapeutic modalities for conversion during episodes and prophylaxis with drugs, various pacing techniques, DC conversion and surgical therapy are discussed. INTERPRETATION: Radiofrequency catheter ablation is the only available method to cure the patient in a gentle manner.

Anti-Arrhythmia Agents↗
PubMed1991

Multiplexing studies of effects of rapid atrial pacing on the area of slow conduction during atrial flutter in canine pericarditis model.

BACKGROUND: We report that rapid atrial pacing interrupts atrial flutter when the orthodromic wave front from the pacing impulse is blocked in an area of slow conduction in the reentry circuit. To characterize the area of slow conduction during atrial flutter and rapid pacing, we studied 11 episodes of induced atrial flutter, mean cycle length 157 +/- 20 msec, in eight dogs with sterile pericarditis. METHODS AND RESULTS: Atrial electrograms were recorded simultaneously from 95 pairs of right atrial electrodes during the interruption of atrial flutter by rapid atrial pacing, mean cycle length 139 +/- 21 msec. Areas of slow conduction during atrial flutter were demonstrated at one to three sites in the reentry circuit. After rapid pacing captured the reentry circuit, one area of slow conduction either disappeared (10 episodes) or the degree of slow conduction in an area of slow conduction decreased (one episode). Both changes were in association with activation of the region by a wave front from the pacing impulse that arrived from a direction different than that during the induced atrial flutter. Interruption of atrial flutter during rapid pacing occurred when the orthodromic wave front from the pacing impulse blocked in an area of slow conduction that had either newly evolved during rapid pacing (seven episodes) or that was previously present (four episodes). CONCLUSIONS: Areas of slow conduction present during atrial flutter and rapid pacing of atrial flutter are functional and depend on both the atrial rate and the direction of the circulating wave fronts. Interruption of atrial flutter by rapid pacing results from block of the orthodromic wave front of the pacing impulse in an area of slow conduction in the reentry circuit.

Animals↗
PubMed2001

Atypical left atrial flutter after intraoperative radiofrequency ablation of chronic atrial fibrillation: successful ablation using three-dimensional electroanatomic mapping.

Curative treatment of chronic atrial fibrillation (AF) remains a challenging task for electrophysiologists. Eliminating the initiating triggers by focal radiofrequency ablation in a subset of patients with paroxysmal AF and modifying the maintaining substrate by performing linear lesions within the left atrium in patients with prolonged episodes of AF are among the alternative approaches for management of these patients. Recently, a new intraoperative treatment procedure aimed at eliminating left atrial anatomic "anchor" reentrant circuits by induction of contiguous lesions using radiofrequency energy under direct vision was introduced. However, atypical left atrial flutter may occur during follow-up after intraoperative ablation of AF. These arrhythmias most likely are due to discontinuities in linear lesions; therefore, they can be successfully mapped and ablated in a subsequent percutaneous catheter ablation procedure. We report and discuss the case of a patient who underwent successful intraoperative ablation of chronic AF, but who developed atypical left atrial flutter postoperatively. Three-dimensional nonfluoroscopic electroanatomic mapping revealed a gap in the linear lesion line connecting the left upper and right upper pulmonary vein orifices. Ablation at the exit site of the breakthrough was successful.

Aged↗
PubMed1997

Radiofrequency catheter ablation in type I atrial flutter: preliminary experience of 10 cases.

Common atrial flutter results from macroreentry in the right atrium. Catheter ablation of slow conduction, between tricuspid annulus and inferior vena cava (TA-IVC) or tricuspid annulus and coronary sinus ostium (TA-CS os) has been reported to terminate and prevent recurrence of this arrhythmia. We reported 10 consecutive patients, 7 men and 3 women, who underwent radiofrequency catheter ablation of common atrial flutter. The mean age was 59.4 +/- 11.2 years (range 42-82 years). During the paroxysmal atrial flutter, all patients had palpitation, 4 had dyspnea on exertion, 3 patients had syncope and 1 patient had presyncope. The mean duration of symptoms was 5.7 +/- 4.9 years (range 0.5-13 years). Two patients had dilated cardiomyopathy, 1 Ebstein's anomaly and 1 chronic obstructive pulmonary disease. Four patients (40%) had history of atrial fibrillation (AF) before ablation. The mean cycle length of atrial rhythm was 257.2 +/- 36.6 ms. Ablation was done by anatomical approach and could terminate arrhythmia in 9 patients (90%), 7 from TA-IVC, 2 from TA-CS os without major complication. The mean number of applications was 20.4 +/- 16.9 and turned atrial flutter to normal sinus rhythm in 13.5 +/- 10.7 seconds. Fluoroscopic and procedure times were 38.4 +/- 31.4 and 157.2 +/- 68.8 minutes, respectively. During the follow-up period of 24.0 +/- 28.7 weeks, 2 patients had recurrent atrial arrhythmia, 1 atrial fibrillation and 1 atrial flutter type I, giving the final success rate of 70 per cent. All patients who had recurrence or failure had a history of paroxysmal AF before ablation. In conclusion, radiofrequency catheter ablation in atrial flutter type I, using anatomical approach, is an effective treatment to terminate and prevent this arrhythmia in short term follow-up. It may be considered as an alternative treatment in patients with atrial flutter who were refractory to antiarrhythmic agents.

Adult↗
PubMed2000

Resumption of right atrial isthmus conduction following atrial flutter radiofrequency ablation.

Right atrial isthmus block is currently accepted as a success criterion of atrial flutter ablation. An electrophysiological study performed days after the ablation procedure may show recovery of conduction across the isthmus in some patients, followed by arrhythmia recurrence. However, few data are available on the time course of this recovery and on the monitoring of isthmus conduction at the end of the ablation procedure as a means of increasing the success rate of the procedure. Radiofrequency (RF) catheter ablation was performed in 28 men and 7 women (mean age = 65 +/- 11 years) presenting with common or clockwise atrial flutter (AFL) resistant to 2.9 +/- 1.8 antiarrhythmic drugs. Underlying heart disease was present in 13 patients. The ablation procedure was performed with an 8-mm-tip catheter, by several 45-second applications at a target temperature of 65 degrees C, directed to the isthmus between tricuspid annulus and inferior vena cava. Bidirectional isthmus block (BDB) was created with 4-24 RF applications in all but one patient. Special attention was paid to exclude incomplete block by meticulous mapping during pacing at the coronary sinus os and at the low lateral right atrium every 5 minutes for 20 minutes thereafter. Conduction recovered across the isthmus in 5 patients at 10, 10, 12, 15, and 16 minutes, respectively, and further RF applications were needed to obtain stable block. At a follow-up of 17 +/- 10 months, AFL occurred in the patient without, and in one patient with BDB. Thirty-three of the 34 patients (97%) with persistent BDB remained free of arrhythmia recurrence. This study showed that conduction resumed across the isthmus within 20 minutes, after AFL ablation in 15% of the patients. The long-term results of the procedure can be optimized by ascertaining the persistence of BDB during that period of time.

Adult↗
PubMed1991

Atrial natriuretic peptide response to cardioversion of atrial flutter and fibrillation and role of associated heart failure.

Plasma atrial natriuretic peptide (ANP) concentrations were measured before and 1 hour after cardioversion in 40 patients (27 with atrial flutter and 13 with atrial fibrillation) admitted for elective cardioversion. Fourteen (11 with atrial flutter and 3 with atrial fibrillation) had clinical evidence of congestive heart failure (CHF). Conversion to sinus rhythm was successful in 39 patients. The mean ANP concentration in the entire group decreased after cardioversion from 38 +/- 4 to 17 +/- 2 pmol/liter (p less than 0.001). In the subgroup with CHF, the ANP level, which was not significantly higher than that in the group without CHF, decreased from 47 +/- 8 to 19 +/- 3 pmol/liter (p less than 0.01). Neither mode of cardioversion (spontaneous 1, pharmacologic 2 and direct-current countershock 36) nor associated CHF influenced ANP response to cardioversion. One patient with atrial flutter and "failed cardioversion" had unchanged ANP level. The decrease after cardioversion in ANP concentration correlated with its control level (r = 0.88, p less than 0.001) but not with the decrease in heart rate. The ANP level in patients with atrial fibrillation was 45 +/- 9 vs 38 +/- 5 pmol/liter in those with atrial flutter (difference not significant). Arrhythmia duration, left atrial size, and ventricular rate or arterial blood pressure did not correlate with ANP concentration in any subgroup. It is concluded that (1) the ANP level is elevated comparably in patients with both atrial flutter and fibrillation regardless of the presence or absence of CHF; and (2) the level decreases, independent of the mode of cardioversion or presence of CHF, promptly after successful cardioversion.

Aged↗
PubMed2004

Noncontact and electroanatomic mapping of atrial flutter in surgically repaired sinus venosus atrial septal defect and rerouting of anomalous pulmonary venous drainage.

Atypical atrial flutter with two prior failed ablations, complicating surgically repaired sinus venosus atrial septal defect and partial anomalous pulmonary venous connection, mapped by noncontact and electroanatomic mapping, is described. Electroanatomic and noncontact mapping clearly identified a narrow zone of normal voltage and activation which was targeted, with successful termination of the arrhythmia.

Adult↗
PubMed2001

[Radiofrequency catheter ablation of atrial flutter].

BACKGROUND: The anatomical structure of atrial flutter is now well recognized, and treatment with radiofrequency catheter ablation (RFA) is established. Several recording and ablation techniques can be applied. MATERIAL AND METHODS: An increasing number of patients have been treated with RFA at the Arrhythmia Centre at Haukeland University Hospital over the last six years. During the two-year period 1999 and 2000, a total of 108 procedures were performed for atrial flutter in a total of 84 patients. A total of 543 RFA procedures for various forms of re-entry tachycardias were performed during the same period; hence, atrial flutter comprised about 20% of RFA procedures. Altogether 71 men and 14 women with a mean age of 57 +/- 12 years were treated. The mean history of atrial flutter had a duration of nine years, maximum 43 years with several hospital admissions, drug trials, overdrive pacing and DC conversion until they were ultimately cured with RFA. RESULTS: The success rate during first time treatment was 96.5%. No serious complications were observed. INTERPRETATION: RFA should be the treatment of first choice in patients with recurrent or incessant atrial flutter.

Adult↗
PubMed1997

The laboratory evaluation and role of catheter ablation for patients with atrial flutter.

The anatomic substrate for atrial flutter has now been recognized, and improved methods for catheter ablation have been developed. Using mapping techniques such as entrainment mapping, recognizing the different types of flutter that can occur, and testing for conduction block with pacing after ablation, long-term cure of atrial flutter can be achieved in most patients with catheter ablation. Not only is catheter ablative cure of atrial flutter the treatment of choice for drug-refractory patients, but also may now be offered as an alternative to drug therapy.

Atrial Flutter↗