Je. Marine et al., Different patterns of interatrial conduction in clockwise and counterclockwise atrial flutter, CIRCULATION, 104(10), 2001, pp. 1153-1157
Citations number
17
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background-The terms counterclockwise (CC) and clockwise (C) atrial flutter
(Afl) are used to describe right atrial. activation around the tricuspid v
alve in the left anterior oblique view. The manner in which the left atrium
is activated, as reflected by coronary sinus (CS) recordings, has not been
systematically evaluated.
Methods and Results-Nine patients with both CC and C Afl underwent electrop
hysiological study with CS recordings during both rhythms with the use of a
decapolar catheter with the tip placed in the distal CS. Patterns of CS ac
tivation during each type of Afl as well as during during sinus rhythm were
categorized into 1 of 3 patterns: sequential proximal-to-distal, sequentia
l distal-to-proximal, and fused, indicating activation from different direc
tions. In 7 of 9 patients, the pattern of CS activation in CC Afl and C Afl
differed, with a proximal-to-distal pattern in CC Afl and a fused pattern
in C Afl. In 2 patients, pacing the high right atrial septum near the presu
med site of Bachmann's bundle in sinus rhythm showed a similar fused patter
n of CS activation.
Conclusions-These results demonstrate different patterns of CS activation i
n CC Afl and C Afl in the majority of patients and are consistent with a mo
del in which the left atrium is activated predominantly over Bachmann's bun
dle during C Afl and over the CS os in CC Afl. These findings may have impl
ications for maintenance of Afl, interpretation of flutter wave morphology
on surface ECG, and left atrial mechanical function in Afl.