کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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5973871 | 1576208 | 2013 | 8 صفحه PDF | دانلود رایگان |
![عکس صفحه اول مقاله: Reentry mechanisms and ablation of ECG-typical atrial flutters involving the cavo-tricuspid isthmus and the proximal coronary sinus Reentry mechanisms and ablation of ECG-typical atrial flutters involving the cavo-tricuspid isthmus and the proximal coronary sinus](/preview/png/5973871.png)
AimReentry circuits of a rare typical atrial flutter (AFL) involving the cavo-tricuspid isthmus (CTI) and proximal coronary sinus (CS) are described based on electrophysiological data and effects of radiofrequency (RF).Methods and resultsTwelve patients with ECG-typical AFL in whom entrainment demonstrated that CTI and proximal CS were both part of the circuit were included. Initial RF target was CTI in 8 patients and proximal CS in 4. Success was defined as AFL termination/noninducibility. After CTI ablation, AFL cycle length (CL) increased in all: AFL persisted in 3, while in the other 5 AFL was interrupted but subsequently induced with the same morphology; before induction CTI bi-directional block was validated; success was obtained at the CS, targeting fragmented atrial potentials (APs). In those with first ablation at CS, AFL was interrupted in 3 with no AFL inducibility; in 1 AFL persisted with CL prolongation and was terminated at CTI. Two reentry patterns were identified: in 5 patients the inter-atrial septum as well as the mid-distal CS were outside of the circuit, while the CTI, proximal CS and Bachmann's bundle zone were inside, suggesting a left atrial component; in 1 patient electrophysiological mapping suggested an intra-CS circuit component. RF was successful in all without recurrence.ConclusionElectrophysiological mapping and RF effects suggest a continuum between the CTI and proximal CS in rare cases with ECG-typical AFL. RF inside the proximal CS, targeting fragmented APs, should be considered in any patient in whom CTI ablation failed to interrupt a typical AFL.
Journal: International Journal of Cardiology - Volume 168, Issue 4, 9 October 2013, Pages 3728-3735