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 865 records · Page 48Linked to original sources
PubMed2004

Outcome after cavo-tricuspid isthmus ablation in patients with recurrent atrial fibrillation and drug-related typical atrial flutter.

This study evaluates the long-term clinical outcome of 56 consecutive patients affected by atrial fibrillation and drug-related typical atrial flutter who underwent cavo-tricuspid isthmus radiofrequency ablation. Symptomatic arrhythmic events recurred after ablation in 64% of the patients during follow-up of 19 +/- 9 months. Even in those who had recurrences, there was a substantial reduction in the incidence of episodes, quality of life was improved, and hospitalizations decreased.

Aged↗
PubMed1994

A case of arrhythmogenic right ventricular dysplasia with atrial flutter.

A 57-year-old male who had arrhythmogenic right ventricular dysplasia (ARVD) with recurrent atrial flutter (AF) is reported. The patient had more frequent episodes of AF than of ventricular arrhythmias. Magnetic resonance imaging, echocardiography and right ventriculography revealed dilatation of the right ventricle and endomyocardial biopsy specimens from the right ventricle showed findings which were compatible with ARVD. The left ventricular specimen, however, also revealed a loss of myocytes and interstitial fibroelastic changes. The present case demonstrates an overlap of post-inflammatory or primary endomyocardial fibroelastic changes with ARVD.

Aged↗
PubMedDate not supplied

[A case of recent atrial flutter treated with intravenous propafenone].

A recently observed case triggers an examination of Propafenone (P.) treatment of atrial flutter (AF). A review of the literature reveals that the question has not so far been sufficiently investigated. In fact only one paper reporting the inadequacy of P. in the treatment of certain forms of AF and atrial fibrillation caused by vagal hypertonia has apparently been published. The case presented here is of a 59 year old man with left bronchial pneumonia in a static phase and an ECG indicating AF. Treatment with P. in slow-release bolus form (2 mg/kg) converted the AF into sinus rhythm in the space of a few minutes. In the absence of any demonstrable cardiac pathology the condition in thought to have been caused by the patient's precarious metabolic status (hypoxaemia, sepsis).

Atrial Flutter↗
PubMed2006

Simple and efficient identification of conduction gaps in post-ablation recurring atrial flutters.

AIMS: Cavo-tricuspid isthmus (CTI) radiofrequency (RF) ablation is a curative therapy for common atrial flutter (AFl), but is associated with a recurrence rate of 5-26%. Although complete bidirectional conduction block is usually achieved, the recurrence of AF is due to recovered conducting isthmus tissue through which activation wavefronts pass. We evaluated a simple and efficient electrophysiological strategy, which pinpoints the ablation target. METHODS AND RESULTS: Twenty-five patients (19 men), mean age 61 +/- 6, with recurrent AFl required a repeat ablation, 250 +/- 160 days after a successful RF CTI procedure. Transverse CTI conduction was monitored during AFl or coronary sinus (CS) pacing by a 24-pole mapping catheter positioned in the right atrium (RA), with the distal poles in the CS, proximal poles on the lateral RA, and intermediate poles on the CTI. A slow conduction area traversing the CTI (velocity, 37 +/- 22 vs. 98 +/- 26 cm/s on either side, P < 0.05) and a lower potential amplitude than at both sides (0.2 +/- 0.15 vs. 0.5 +/- 0.5 mV, P < 0.05), defined by a bayonet-shaped depolarization sequence, were considered to represent the incomplete line of block (InLOB). An ablation catheter was progressively dragged up to this InLOB, from the tricuspid annulus to the inferior vena cava, analysing the widely separated double potentials (DPs) until these coalesced. In nine patients (35%), the target conduction gap was a coalesced fractionated atrial potential within the InLOB (duration, 77 +/- 12 ms), and in 16 patients (65%), a narrow DP toward the healthy margins of this InLOB (duration, 28 +/- 15 ms). Adopting this strategy yields 100% successful re-ablation of recurring AFl leading to bidirectional block, with a mean 2.7 +/- 1.4 RF applications. CONCLUSION: Transverse CTI mapping precisely locates the InLOB and helps find conduction gaps along the CTI in re-ablation procedures for common AFl.

Atrial Flutter↗
PubMed2000

Influence of right atrial structure on outcome of radio-frequency catheter ablation for common atrial flutter.

Radiofrequency catheter ablation (RFCA) targeting the cavotricuspid isthmus is usually an effective treatment for common atrial flutter (AFL), except in a small subset of patients and the reason for this has yet to be elucidated. The present study investigated the relationship between the outcome of RFCA for common AFL and the anatomy of the right atrium as seen on angiography. Twenty consecutive patients who underwent RFCA for common AFL were divided into 2 groups according to the results of RFCA. Group A comprised 13 patients whose AFL was abolished, fulfilling the criteria of success by the conventional catheter approach, and group B comprised 7 patients whose AFL could not be abolished according to the criteria for success (n=4) or was abolished following an additional superior vena cava approach (n=3). On angiography, the cavotricuspid isthmus was longer (3.5+/-0.5 vs 2.2+/-0.6 cm) and deeper (0.94+/-0.35 vs 0.49+/-0.19 cm) in group B than in group A (both p<0.01). The height of the eustachian valve was also greater in group B than in group A (1.4+/-1.1 vs 0.48+/-0.48 cm, p<0.02). These results suggest that the anatomical structure of the cavotricuspid isthmus affects the outcome of RFCA for common AFL.

Adolescent↗
PubMed2004

Catheter-based cryoablation permanently cures patients with common atrial flutter.

BACKGROUND: Cryoablation (cryo) has a high success rate in the short-term treatment of atrial flutter (AFL), but evidence of long-term efficacy is lacking. The present study reports the long-term effect of cryo of the cavotricuspid isthmus (CTI) in patients with common AFL. METHODS AND RESULTS: Thirty-five consecutive patients (28 men; mean age, 53 years) underwent cryo of the CTI. In 34 patients, the AFL had a counterclockwise rotation (cycle length, 242+/-43 ms). Eleven patients had structural heart disease. Cryo was performed with a 10F catheter with a 6-mm-tip electrode (CryoCor). Applications (3 to 5 minutes each) were delivered by use of a point-by-point technique to create the ablation line. The acute end point of the procedure was creation of bidirectional isthmus conduction block and noninducibility of AFL. A median of 14 applications (range, 4 to 30) at 10 sites (range, 4 to 19) was given along the CTI with a mean temperature of -80.0+/-5.0 degrees C. Mean fluoroscopy and procedure times were 40+/-26 minutes and 3.2+/-1.3 hours, respectively. Of the 35 patients, 34 were acutely successfully ablated (97%). After a mean follow-up of 17.6+/-6.2 months (range, 9.6 to 26.1 months), 31 patients (89%) did not have recurrence of AFL. Three of the 4 patients with recurrence had a second successful procedure. One patient had transient ST elevation in the inferior leads during cryoapplication. CONCLUSIONS: Cryo produces permanent bidirectional isthmus conduction block of the CTI. Short- and long-term success rates are comparable to those for radiofrequency ablation.

Adult↗
PubMed1992

[Therapeutic effectiveness of left atrial transesophageal electric stimulation in atrial flutter].

The efficiency of frequent asynchronous transesophageal electrical stimulation (TEES) of the left atrium in atrial flutter of various origin was analyzed in 62 patients. It was found to be depended on the etiology and duration of arrhythmia and on the frequency of atrial waves. The best results were obtained in patients with postmyocardial cardiosclerosis and coronary heart disease in acute arrhythmias and at a low (less than 300 per min) frequency of flutter waves.

Adult↗
PubMed1978

Self-initiated conversion of paroxysmal atrial flutter utilizing a radio-frequency pacemaker.

A patient is described with drug-resistant recurrent paroxysmal atrial flutter. Electrophysiologic studies demonstrated that flutter was inducible with rapid atrial stimulation (stimulation rates of 375 to 400/min) and convertible with rapid atrial stimulation (rates of 400 to 460/min). Because of the latter response, a radio-frequency atrial pacemaker was implanted, which allowed self-initiated conversion of flutter episodes with rapid stimulation.

Arrhythmias, Cardiac↗
PubMed2002

Variable electrocardiographic characteristics of isthmus-dependent atrial flutter.

OBJECTIVES: The purpose of this study was to characterize variations in flutter-wave (F-wave) morphology among patients with clockwise isthmus-dependent (CWID) and counterclockwise isthmus-dependent (CCWID) right atrial flutter (AFL) and to attempt to correlate F-wave morphology with echocardiographic data and clinical patient characteristics. BACKGROUND: Variations in F-wave morphology on surface electrocardiogram (ECG) during CCWID and CWID flutter have been reported but never systematically characterized. METHODS: Over a four-year period, 139 patients with AFL on ECG underwent electrophysiologic study and echocardiography at our institution. Electrocardiographic data, intracardiac recordings, echocardiographic data, and patient characteristics were reviewed retrospectively. RESULTS: Of 156 AFLs evaluated, 130 were CCWID, 26 were CWID. Three types of CCWID flutter were observed: type 1 had purely negative F-waves inferiorly, types 2 and 3 had F-waves inferiorly with small (type 2) or broad (type 3) positive terminal deflections; CCWID flutter types 2 and 3 were associated with higher incidence of left atrial (LA) enlargement, heart disease, and atrial fibrillation (Afib) than type 1. Two types of CWID flutter were observed: type 1 had notched positive F-waves with a distinct isoelectric segment inferiorly. Type 2 had broader F-waves inferiorly with positive and negative components and a short isoelectric segment. CONCLUSIONS: Variable ECG patterns for CCWID and CWID AFL exist. A positive component of the F-wave in the inferior leads during CCWID flutter is associated with an increased likelihood of heart disease, Afib, and LA enlargement.

Adult↗
PubMed2000

Clinical significance of residual slow cavotricuspid isthmus conduction after ablation of typical atrial flutter.

The purpose of this study was to evaluate the clinical significance of residual slow cavotricuspid isthmus (IT) conduction on the ablation line after typical atrial flutter (AF) ablation, undetected by analysis of right atrial (RA) activation. Seventy patients with AF underwent IT ablation. In the first 35 patients (group I), IT block was verified only by the RA activation sequence. In the subsequent 35 patients (group II), IT block was verified by the presence of parallel double potentials with an isoelectric interval through the entire ablation line (in addition to RA activation sequence criteria) during pacing from the low lateral RA and the coronary sinus ostium. In group I patients, residual IT conduction was retrospectively analyzed at the ablation site immediately after the last radiofrequency (RF) application. Six of 33 group I patients (18%) with IT block had residual IT conduction represented by fractionated or multicomponent potentials immediately after the final RF application. Four of these 6 patients (67%) had recurrences of AF, 3 +/- 1.4 months after ablation. Four (12%) of 33 group II patients with IT block had residual IT conduction in the ablation line after creation of IT block confirmed by RA activation sequence. This conduction was eliminated by 1.6 +/- 0.9 further RF applications in all 4 patients. No AF recurrence was observed in group II patients. Up to 18% of patients with apparent IT ablation had residual slow IT conduction on the ablation line. This conduction was associated with AF recurrences and must be eliminated to achieve complete cure of AF.

Aged↗
PubMed2000

Ventricular tachycardia as a complication of atrial flutter ablation.

A 61-year-old woman with dilated cardiomyopathy, who previously underwent successful radiofrequency catheter ablation for atrial flutter, developed monomorphic ventricular tachycardia (VT). The site of VT origin was the inferobasal right ventricle adjacent to the previous atrial isthmus ablation area. The most likely mechanism for the VT was scar-related reentry, the scar being the result of previous radiofrequency lesions in the atrial isthmus. The VT was successfully ablated.

Atrial Flutter↗
PubMed2002

Identification of extremely slow conduction in the cavotricuspid isthmus during common atrial flutter ablation.

INTRODUCTION: Complete isthmus block has been used as an endpoint for radiofrequency ablation for common atrial flutter (AF). We sought to systematically evaluate extremely slow conduction (ESC), which is easily misinterpreted as complete block. METHODS AND RESULTS: We studied 107 consecutive patients (92 men, 15 women, 58 +/- 11 years) who had undergone a successful AF ablation procedure. A 24-pole catheter was positioned along the tricuspid annulus spanning the isthmus. Complete isthmus block was defined as the presence of a complete corridor of double potentials along the ablation line. Activation delay time (AT), activation difference (deltaA) between two adjacent dipoles, maximum activation difference (deltaA(max)), change in polarity (CP) and change in amplitude (CA) of the bipolar atrial electrogram were recorded and P-wave morphology in the surface electrocardiogram was analyzed. ESC was observed in 16 patients. Between ESC and complete block, differences were found on the two lateral dipoles adjacent to the ablation line (AT: 148 +/- 17 vs. 183 +/- 27 ms and 155 +/- 18 vs. 170 +/- 28 ms, P < 0.01; deltaA: -91 +/- 22 vs. -126 +/- 28 ms and -7 +/- 13 vs. 13 +/- 6 ms, P < 0.01). Statistically significant differences in CP were detected on the relevant dipoles (7/16 vs. 14/16 and 6/16 vs.13/16, P < 0.05). No significant difference was found either in CA or in terminal P wave positivity. Mean deltaA(max) were 13.8 +/- 5.0 and 27.8 +/- 9.5 ms (P < 0.001) respectively in ESC and complete block. Two types of ESC, regular and irregular, were demonstrated during the ablation procedure. CONCLUSIONS: (1) ESC was observed in 15% of the patients during the AF ablation procedure. (2) The parameters of AT, deltaA, and CP may help to differentiate ESC from complete block. DeltaA(max) might be the most powerful indicator. (3) To verify complete block, it is essential to position the mapping catheter across the CTI in order to demonstrate the activation sequence up to the ablation line.

Aged↗
PubMed1988

Noninvasive diagnosis and treatment of atrial flutter utilizing previously implanted dual chamber pacemaker.

Patients with previously implanted dual chamber pacemakers (PM) may develop atrial flutter (AFL). The Siemens-Pacesetter AFP and Genesis PM have the capability of noninvasively synchronizing to a standard external electrophysiology (EP) stimulator. Any arrhythmia termination or induction protocol may be used with a refractory period limitation of approximately 127 msec (472 ppm). The PM stimulation sequence is directly controlled by the APS Model 370EP Programmer which acts as an interface between the PM and EP stimulator. All testing is conducted with the PM functioning in a single chamber mode. The external EP stimulation is detected by the programmer and a 37 KHz coded radio frequency transmission is used to control the PM stimulation in a 1:1 fashion. Real-time intracardiac electrograms (IEG) can be recorded from either the atrial (A) or ventricular lead. The IEG can be used for: (1) hard-copy for diagnosis and cycle length determination; (2) monitoring during and after the procedure; and (3) a synchronization signal to the EP stimulator. Two patients presented with three episodes of AFL with A rates ranging from 220-290 bpm. An A-IEG was obtained in each case to document the exact rhythm and rate. Rapid A pacing from 300-340 ppm was accomplished using a standard external rapid A pacemaker in concert with the 370EP programmer and PM. In two episodes, the AFL accelerated to transient A fibrillation followed by spontaneous conversion to sinus rhythm (SR). In the other episode, the AFL converted directly to SR.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[Familial manifestation of idiopathic atrial flutter].

We describe, to the best of our knowledge for the first time, the occurrence of idiopathic atrial flutter (AF) in two male children of a family. The two brothers are the third and sixth of seven children, and the only males. The parents do not suffer from any heart disease. The first sister died in Turkey at the age of twenty days. The parents do not know the cause of death. The fourth sister died at de age of five years, also in Turkey, probably because of meningitis. Electrocardiograms of the parents and the other three sisters are normal. Besides the unique familial occurrence, the AF themselves offer some unusual features. In the first patient, the AF could not be converted to sinus rhythm. In the second patient, the AF occurred paroxysmally, and in addition to the AF, the electrocardiogram tracings revealed paroxysmal atrial tachycardia.

Adolescent↗
PubMed1978

Idiopathic atrial flutter in infancy: a review of eight cases.

The experience of three institutions in the management of atrial flutter in infants under 2 years of age without associated heart disease is reviewed. Five babies with neonatal onset were treated with digoxin and had uncomplicated resolution of their arrhythmia, although one continued to have episodes of paroxysmal supraventricular tachycardia for six years. Two of the three older infants required DC cardioversion for complications after quinidine was substituted for digoxin therapy. Digoxin continues to be the preferred initial therapy for non-acutely ill patients; those showing signs of cardiac decompensation should be converted with DC countershock.

Atrial Flutter↗
PubMed1975

Electrophysiologic studies in a patient with atrial flutter and 1:1 atrioventricular conduction.

Intracardiac electrophysiologic studies were performed in a patient having paroxysms of atrial flutter with 1:1 atrioventricular (A-V) conduction. Although duration of conduction intervals was normal during sinus rhythm, the atrio-His (A-H) interval did not show the expected increase when the atria were stimulated at progressively higher rates. The results of pacing with the extrastimulus technique also indicated that the refractory periods of the A-H tissues were shorter than normal. Yet, intravenously administered ouabain produced a significant increase in these refractory periods. The findings in the case are compatible with a partial A-V nodal bypass with a shorter refractory period than the A-V node or with an A-V node with unusual capacity for rapid conduction. The response to ouabain therapy was that of A-V nodal tissues.

Adult↗
PubMed2002

Unidirectional conduction block at cavotricuspid isthmus created by radiofrequency catheter ablation in patients with typical atrial flutter.

INTRODUCTION: Although unidirectional conduction block at the cavotricuspid isthmus can be created by radiofrequency ablation for atrial flutter, its underlying mechanism has not been elucidated. METHODS AND RESULTS: Twenty-seven patients (22 men and 5 women; mean age 59 +/- 11 years) who met the following criteria were studied: (1) bidirectional isthmus conduction demonstrable at baseline; (2) at least one linear lesion attempted on the cavotricuspid isthmus with radiofrequency catheter ablation; and (3) conduction times at anterolateral and posteromedial portions of the isthmus measured for both clockwise and counterclockwise directions before the ablation procedure. Unidirectional conduction block was observed before achieving bidirectional block in 9 patients (group I); the remaining 18 patients did not exhibit unidirectional conduction block (group II). All unidirectional conduction blocks were demonstrated in the counterclockwise direction. Anterolateral isthmus conduction time in group I was significantly longer than that in group II in both directions. However, there were no significant differences in posteromedial isthmus conduction time between groups I and II in either direction. Anterolateral isthmus conduction time was significantly longer than posteromedial conduction time in group I but not in group II. CONCLUSION: There were significant differences in conduction properties at the cavotricuspid isthmus between patients who developed unidirectional conduction block and those who did not. Our results support the notion that anisotropy contributes to the genesis of unidirectional conduction block at the cavotricuspid isthmus during the radiofrequency ablation procedure.

Aged↗