Comparison of clockwise and counterclockwise right atrial flutter using high‐resolution mapping and automated velocity measurements.
Background: Only few studies have been performed that explore the electrophysiological differences between clockwise (CW) and counterclockwise (CCW) right atrial (RA) cavotricuspid isthmus (CTI)‐dependent atrial flutter (AFL) using the high‐resolution Rhythmia mapping system. Objectives: We sought t...
| Publicado en: | Journal of Cardiovascular Electrophysiology Vol. 32; no. 8; pp. 2127 - 2140 |
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| Autores principales: | , , , , , , , , |
| Formato: | diagnostic images research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Aug2021
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=151782888&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 151782888 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10453873 GSB jtl: Journal of Cardiovascular Electrophysiology issn: 10453873 maglogo: Y pubinfo: dt: Aug2021 vid: 32 iid: 8 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 151782888 150662653 151782888 151782888 10.1111/jce.15111 151782888 ppf: 2127 ppct: 13 formats: fmt: – @attributes: type: T – @attributes: type: C – @attributes: type: P tig: atl: Comparison of clockwise and counterclockwise right atrial flutter using high‐resolution mapping and automated velocity measurements. aug: au: Yvorel, Cedric Da Costa, Antoine Lerebours, Chloe Guichard, Jean B. Viallon, Gregory Romeyer, Cécile Ferreira, Thomas Benali, Karim Isaaz, Karl affil: Division of Cardiology, Jean Monnet University, Saint‐Etienne, France sug: subj: Heart Atrium, Right Physiopathology Atrial Flutter Physiopathology Body Surface Potential Mapping Methods Printing, Three-Dimensional Methods Blood Flow Velocity Evaluation Automation Models, Statistical Electrophysiology Human Cardiac Patients Aged Aged, 80 and Over Descriptive Statistics Image Processing, Computer Assisted Tachycardia Heart Conduction System Physiopathology Heart Atrium, Right Radiography Atrial Flutter Radiography Aged: 65+ years Aged, 80 & over ab: Background: Only few studies have been performed that explore the electrophysiological differences between clockwise (CW) and counterclockwise (CCW) right atrial (RA) cavotricuspid isthmus (CTI)‐dependent atrial flutter (AFL) using the high‐resolution Rhythmia mapping system. Objectives: We sought to compare CW and CCW CTI‐dependent AFL in pure right AFL patients (pts) using the ultra‐high‐definition (ultra‐HD) Rhythmia mapping system and we mathematically developed a cartography model based on automatic velocity RA measurements to identify electrophysiological AFL specificities. Methods and Results: Thirty‐three pts were recruited. The mean age was 71 ± 13 years old. The sinus venosus (SV) block line was present in 32/33 of cases (97%) and no significant difference was found between CCW and CW CTI AFL (100% vs. 91%; p =.7). No line was localized in the region of the crista terminalis (CT). A superior gap was present in the posterior line in 14/31 (45.2%) but this was similarly present in CCW AFL, when compared to CW AFL (10/22 [45.5%] vs. 4/10 [40%]; p =.9). When present, the extension of the posterior line of block was observed in 18/31 pts (58%) without significant differences between CCW and CW CI AFL (12/22 [54.5%] vs. 6/10 [60%]; p =.9) The Eustachian ridge line of block was similarly present in both groups (82% [18/22] vs. 45.5% [5/11]; p =.2). The absence of the Eustachian ridge line of block led to significantly slowed velocity in this area (28 ± 10 cm/s; n = 8), and the velocities were similarly altered between both groups (26 ± 10 [4/22] vs. 29.8 ± 11 cm/s [4/11]; p =.6). We created mathematical, three‐dimensional RA reconstruction‐velocity model measurements. In each block localization, when the block line was absent, velocity was significantly slowed (≤20 cm/s). A systematic slowdown in conduction velocity was observed at the entrance and exit of the CTI in 100% of cases. This alteration to the conduction entrance was localized at the lateral side of the CTI for the CCW AFL and at the septal side of the CTI for CW AFL. The exit‐conduction alteration was localized at the CTI septal side for the CCW AFL and at the CTI lateral side for the CW AFL. Conclusion: The ultra‐HD Rhythmia mapping system confirmed the absence of significant electrophysiological differences between CCW and CW AFL. The mechanistic posterior SV and Eustachian ridge block lines were confirmed in each arrhythmia. A systematic slowing down at the entrance and exit of the CTI was demonstrated in both CCW and CW AFL, but in reverse positions. pubtype: Academic Journal doctype: diagnostic images research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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