Atrial flutter
Dotaz
Zobrazit nápovědu
49 patients with 53 episodes of atrial flutter were treated by rapid atrial pacing. Sinus rhythm was attained in 55%, atrial fibrillation in 26%, type II flutter in 9% of patients. In the other cases, the effect on atrial action was only slight or short-lasting. Among the causes of the unsuccessful outcome of treatment, the authors include--besides insufficient rate and duration of pacing, bad electrode contact in the atrium and insufficient outlet current--specific properties of the type of flutter (impure flutter, type II flutter, type I atrial fibrillation, uncommon flutter) as well as unsuitable indication (mitral defect, thyrotoxicosis).
- MeSH
- elektrokardiografie MeSH
- fibrilace síní etiologie MeSH
- flutter síní terapie MeSH
- kardiostimulace umělá * MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Atrial flutter is a common cardiac dysrhythmia which responds for half of the supraventricular tachycardias with exception of atrial fibrillation. Activation and entrainment mapping studies in man and in animals confirmed the reentry mechanism of atrial flutter and demonstrated that the reentry circuit is located in the right atrium. The most important anatomical structures which enable the occurrence of atrial flutter are crista terminalis, Eustachian valve/ridge and tricuspid annulus. In typical atrial flutter the impulse rotates "counterclockwise". According to the present knowledge the reentry circuit surrounds a central obstacle made by the orifices of the superior and inferior vena cava linked by a line of functional block in the region of crista terminalis. The anterior barrier is created by tricuspid annulus. The anterolateral wall of the right atrium is activated craniocaudally. Crista terminalis and tricuspid annulus form a funnel which leads the impulse into the isthmus with slow conduction located between the vena cava orifice and tricuspid annulus. Septal activation is ascending and the activation wave considerably widens and becomes irregular. The upper link of the circuit is located above and anteriorly to the superior vena cava. The left atrium is activated passively and does not play an important role in the reentrant circuit. Reverse flutter has the same substrate as typical flutter but rotates in an opposite "clockwise" manner.
- MeSH
- elektrofyziologie MeSH
- flutter síní patofyziologie MeSH
- lidé MeSH
- převodní systém srdeční patofyziologie MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
Functional and structural changes, the enlargement of the right atrium is the background for the development of typical atrial flutter (AFL). These changes in ECG are manifested in the morphology of the initial part of the P-wave. The aim of the study was to assess the duration and morphology of the P-wave in patients with paroxysmal and persistent AFL. The study population consisted of 131 patients with AFL, 38 women and 93 men aged 66 years (60-72), divided in 62 patients with paroxysmal and 69 with persistent AFL. P-wave duration was measured with an electrophysiological system in all leads at a paper speed of 200 mm/s. The groups did differ in terms of gender (38/24 vs. 55/14, (M/F), p=0.033). Patients with persistent AF had a longer P-wave duration - 175±26.3 ms vs. 159±22.6 ms, p=0.01, and higher creatinine concentration - 1.2±0.60 mg/dl vs. 1.08±0.68 mg/dl, p=0.007. The presence and severity of interatrial conduction block (I-none, II-partial, III-total) was related to age of the patients (60.3±12.1 vs. 64.7±-8.3 vs. 68.9±9.5 years, respectively). Patients with persistent AFL show a longer P-wave compared to paroxysmal AFL, regardless of comorbidities and antiarrhythmic drugs. The arrhythmia-related longer P-wave duration should encourage the clinicians to restore sinus rhythm earlier in order to more effectively maintain it over the long term.
- MeSH
- antiarytmika terapeutické užití MeSH
- elektrokardiografie MeSH
- fibrilace síní * MeSH
- flutter síní * diagnóza farmakoterapie epidemiologie MeSH
- lidé MeSH
- srdeční síně MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- antiarytmika MeSH
BACKGROUND: Radiofrequency ablation of common atrial flutter requires the creation of a complete transmural ablation line across cavotricuspid region to achieve bidirectional conduction block. Irrigated tip catheters facilitate rapid achievement of this block by creation larger and deeper lesions. The EASTHER registry was organized to collect data about the efficacy of the procedure in small and middle volume centres in Central and Eastern Europe, all using THERMOCOOL catheter technology. METHODS: Easther is a prospective registry (April 2002-February 2003). 133 consecutive patients (81.1% male, age 59.0 +/- 10.4 years, range 30-81 years) with common atrial flutter were enrolled. Coincidence with atypical flutter was observed in 2.7%. Patients had a history of flutter of 31.0 +/- 53.6 month (range 1-403) and concomitant atrial fibrillation was observed in 42.9%. Structural heart disease was present in 38.9%. Amount of re-ablated cases was 14%. RF energy was applied during 60 sec in power-controlled mode at a setting between 40 to 50 W with an average flow rate of 19.0 ml/min. RESULTS: Acute success rate defined as bi-directional block was achieved in 93.1%, although 94.7% of cases were assessed successful by the treating electrophysiologist. Average number of RF applications was 12.0 +/- 7.0 (range 2-40) per procedure. Average delivered power varied between a minimum of 36.1 +/- 15.1 W till a maximum of 45.3 +/- 13.0 W, while the average maximum temperature observed at the same time was varied between 39.0 +/- 3.4 degrees C and 45.4 +/- 4.0 degrees C. Total procedure time was 100.1 +/- 42.7 min (range 20-280 min) and fluoroscopy time was 15.8 +/- 9.6 min (range 4-45 min). In comparable French TC registry Average total and fluoroscopy time were 46.4 +/- 33.6 min, and 10.0 +/- 6.8 min resp. In the Middle European centres total and fluoroscopy time was 96.1 +/- 40.9 min, and 15.0 +/- 8.9 min resp. In centres from Eastern Europe it was 120.3 +/- 51.2 min, and 20.4 +/- 11.9 min resp. Two adverse events were reported. Both patients had strong chest pain during ablation. These results are comparable with the literature data published. CONCLUSIONS: Irrigated tip catheters are effective and safe in ablation of common atrial flutter. This technology helps to accelerate and facilitate achievement of bi-directional isthmus block. Most of procedures were terminated to one hour in experienced centers in France as early as 2002. Procedures not exceeding one hour are feasible in case of spreading this method as method of first choice with gaining of experiences in centres of Middle and Eastern Europe.
- MeSH
- časové faktory MeSH
- dospělí MeSH
- elektrokardiografie MeSH
- flutter síní diagnóza chirurgie MeSH
- katetrizační ablace * přístrojové vybavení metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- multicentrická studie MeSH
- MeSH
- antikoagulancia aplikace a dávkování MeSH
- elektrická defibrilace * škodlivé účinky MeSH
- embolie etiologie prevence a kontrola MeSH
- fibrilace síní terapie MeSH
- flutter síní terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- rizikové faktory MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- antikoagulancia MeSH
INTRODUCTION: Conduction recurrence during radiofrequency (RF) ablation of cavotricuspid isthmus for typical atrial flutter is common. Understanding the temporal pattern of recurrences could help to predict a durable bidirectional block (BDB) and optimize the procedure. METHODS AND RESULTS: We analyzed atrial flutter ablations in 108 consecutive patients (85 males, age 63 +/- 11 years). RF energy was delivered through 8-mm tip or 4-mm cooled-tip catheter. On average, 18 +/- 11 pulses were necessary to achieve BDB. The time to recurrence of conduction after RF cessation was recorded. Early and late conduction recurrences were defined as < or =10 minutes and >10 minutes, respectively. Patients were observed for > or =30 minutes after bidirectional cavotricuspid isthmus (CTI) block was achieved. Conduction did not recur in 46 patients. In 8 cases, no block was achieved. A total of 167 conduction recurrences were recorded in the remaining 54 cases (1-10 per case). Of these, in 53 patients, recurrences were classified as early (98%) and 14 patients had late recurrences (8%). Thirteen patients had both early and late recurrences (24%). All but one late recurrence were preceded by at least one early recurrence. Absence of early recurrence had negative predictive value of 98%, while any early recurrence had positive predictive value of 26% for subsequent late conduction recovery. CONCLUSION: Incidence of isthmus conduction recurrence rapidly decayed during the waiting period. Absence of conduction recurrence within 10 minutes after first successful RF delivery was highly predictive of persistent BDB.
- MeSH
- časové faktory MeSH
- flutter síní patofyziologie chirurgie MeSH
- katetrizační ablace * metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- převodní systém srdeční patofyziologie MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Although cycle length (CL) constitutes a fundamental descriptor of any arrhythmia, there is not larger study describing mean CL in electrophysiologically confirmed cavo-tricuspid isthmus (CTI)-dependent atrial flutter (AFL). We analyzed retrospectively digital recordings of 121 patients (98 men; age 64+/-11 years) referred for radiofrequency ablation of persistent CTI-dependent AFL. Median of mean AFL CL was 240 ms (interquartile range (IQR) of 222-258 ms, overall range of 178-399 ms). The distribution of CL was not normal (Shapiro Wilk test, p<0.001). Both counterclockwise and clockwise (14.9 % of all cases) AFLs were comparable in their CL; 240 (IQR 222-258) ms vs. 234 (217-253) ms, respectively. AFL CL<200 ms and AFL CL<190 ms was noticed in 5 (4.1 %) and 3 cases (2.5 %), respectively. In multivariate regression analysis, age (increase by 6+/-3 ms per decade of age, p=0.036), treatment with specific antiarrhythmic drugs (increase by 11+/-6 ms, p=0.052) and the history of cardiac surgery (increase by 26+/-9 ms, p=0.004) were independently associated with AFL CL. In conclusions, the distribution of AFL CL is not normal. The prevalence of AFL with short CL is low. Short CL<200 ms does not rule out the CTI-dependent AFL, especially in young and otherwise healthy patients.
- MeSH
- flutter síní patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- regresní analýza MeSH
- retrospektivní studie MeSH
- senioři MeSH
- trikuspidální chlopeň patofyziologie MeSH
- vena cava inferior patofyziologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- MeSH
- dospělí MeSH
- elektrokardiografie MeSH
- fetální srdce MeSH
- flutter síní vrozené MeSH
- lidé MeSH
- nemoci plodu diagnóza MeSH
- novorozenec MeSH
- těhotenství MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
The risk of possible complications in atrial flutter leads to attempts to use all available therapeutic possibilities to eliminate this disorder of the cardiac rhythm. By oesophageal stimulation the sinus rhythm was restored in 40% and a change to atrial fibrillation was achieved in 50% of the patients. The advantages of this method include above all speed and the minimal risk of complications; the disadvantage of the method is the unpleasant sensation when the electrode is inserted and the painful perception of the stimuli. Oesophageal stimulation can be recommended as the method of choice in treatment of atrial flutter.
- MeSH
- flutter síní terapie MeSH
- kardiostimulace umělá * metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
