Atrial Flutter

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Albert L Waldo - One of the best experts on this subject based on the ideXlab platform.

  • Inter-relationships between Atrial Flutter and Atrial fibrillation.
    Pacing and clinical electrophysiology : PACE, 2020
    Co-Authors: Albert L Waldo
    Abstract:

    It has been appreciated for a long time that Atrial Flutter and Atrial fibrillation have a clinical relationship. Now, with the technological advances that permit more sophisticated electrophysiological studies, especially mapping studies, we have significantly advanced our understanding of this interrelationship. Regarding the relationship at Atrial fibrillation to Atrial Flutter: Atrial fibrillation of variable duration (very brief to prolonged episodes) precedes the onset of Atrial Flutter in most instances. It seems that during the period of Atrial fibrillation, the functional components of the Atrial Flutter reentrant circuit are formed. This is principally a line of block between the venae cavae. If this line of block does not form, classical Atrial Flutter does not form. And if this line of block shortens or disappears, classical Atrial Flutter disappear as well. In fact, it might be said that the major difference in whether classical Atrial Flutter or Atrial fibrillation develops is whether a line of block forms between the venae cavae. Regarding the relationship of Atrial Flutter to Atrial fibrillation: Studies have demonstrated that a driver (a single focus or reentrant circuit of very short cycle length) can be responsible for causing Atrial fibrillation by producing fibrillatory conduction to the rest of the atria. In experimental models and now beginning to be demonstrated in patients, this driver may be a stable reentrant circuit of very short cycle length, i.e., a fast form of Atrial Flutter, if you will. In fact, there is probably a spectrum of these short cycle lengths that depend, in part, on where the reentrant circuit (i.e., "Atrial Flutter") exists. When the stable reentrant circuit is of sufficiently short cycle length, it will only activate small portions of the atria in a 1 : 1 manner. The rest of the atria will be activated irregularly, resulting in Atrial fibrillation. Unstable reentrant circuits can also do the same thing. In short, it appears that there are several mechanisms of Atrial fibrillation, one of which is due to a form of very rapid Atrial Flutter.

  • The Interrelationship Between Atrial Fibrillation and Atrial Flutter
    Progress in Cardiovascular Diseases, 2005
    Co-Authors: Albert L Waldo
    Abstract:

    Abstract For a long time, it has been known that Atrial fibrillation and Atrial Flutter have a close clinical interrelationship. Recent electrophysiological studies, especially mapping studies, have significantly advanced our understanding of this interrelationship. Regarding the relationship of Atrial fibrillation with Atrial Flutter: Atrial fibrillation of variable duration precedes the onset of Atrial Flutter in almost all instances. During the Atrial fibrillation, the functional components needed to complete the Atrial Flutter reentrant circuit, principally a line of block between the venae cavae, are formed. If this line of block does not form, classical Atrial Flutter does not develop. If this line of block shortens or disappears, classical Atrial Flutter disappears. In fact, it is fair to say that the major determinant of whether Atrial fibrillation persists or classical Atrial Flutter develops is whether a line of block forms between the venae cavae. Regarding the relationship of Atrial Flutter with Atrial fibrillation: Studies in experimental models and now in patients have demonstrated that a driver (a rapidly firing focus or a reentrant circuit of very short cycle length) can cause Atrial fibrillation by producing fibrillatory conduction to the rest of the atria. When the driver is a stable reentrant circuit of very short cycle length, it is, in effect, a very fast form of Atrial Flutter. There probably is a spectrum of reentrant circuits of short cycle length, i.e., "Atrial Flutter," that depend, in part, on where the reentrant circuit is located. When the cycle length of the reentrant circuit is so short that it will only activate small portions of the atria in a 1:1 manner, the rest of the atria will be activated rapidly but irregularly, i.e., via fibrillatory conduction, resulting in Atrial fibrillation. In short, there are probably several mechanisms of Atrial fibrillation, one of which is due to a very rapid Atrial Flutter circuit causing fibrillatory conduction. In sum, Atrial fibrillation and Atrial Flutter have an important interrelationship.

  • Inter-relationships between Atrial Flutter and Atrial fibrillation
    Pacing and Clinical Electrophysiology, 2003
    Co-Authors: Albert L Waldo
    Abstract:

    WALDO, A.L.: Inter-Relationships Between Atrial Flutter and Atrial Fibrillation. It has been appreciated for a long time that Atrial Flutter and Atrial fibrillation have a clinical relationship. Now, with the technological advances that permit more sophisticated electrophysiological studies, especially mapping studies, we have significantly advanced our understanding of this interrelationship. Regarding the relationship at Atrial fibrillation to Atrial Flutter: Atrial fibrillation of variable duration (very brief to prolonged episodes) precedes the onset of Atrial Flutter in most instances. It seems that during the period of Atrial fibrillation, the functional components of the Atrial Flutter reentrant circuit are formed. This is principally a line of block between the venae cavae. If this line of block does not form, classical Atrial Flutter does not form. And if this line of block shortens or disappears, classical Atrial Flutter disappear as well. In fact, it might be said that the major difference in whether classical Atrial Flutter or Atrial fibrillation develops is whether a line of block forms between the venae cavae. Regarding the relationship of Atrial Flutter to Atrial fibrillation: Studies have demonstrated that a driver (a single focus or reentrant circuit of very short cycle length) can be responsible for causing Atrial fibrillation by producing fibrillatory conduction to the rest of the atria. In experimental models and now beginning to be demonstrated in patients, this driver may be a stable reentrant circuit of very short cycle length, i.e., a fast form of Atrial Flutter, if you will. In fact, there is probably a spectrum of these short cycle lengths that depend, in part, on where the reentrant circuit (i.e., "Atrial Flutter") exists. When the stable reentrant circuit is of sufficiently short cycle length, it will only activate small portions of the atria in a 1 : 1 manner. The rest of the atria will be activated irregularly, resulting in Atrial fibrillation. Unstable reentrant circuits can also do the same thing. In short, it appears that there are several mechanisms of Atrial fibrillation, one of which is due to a form of very rapid Atrial Flutter.

  • Treatment of Atrial Flutter
    Heart, 2000
    Co-Authors: Albert L Waldo
    Abstract:

    After Atrial fibrillation, Atrial Flutter is the most important and most common Atrial tachyarrhythmia. Although it was first described 80 years ago, techniques for its diagnosis and management have changed little for decades. The diagnosis rested almost entirely with the 12 lead ECG, and treatment options included only the use of a digitalis compound to slow and control the ventricular response rate, and/or the use of either quinidine or procainamide in an attempt to convert the rhythm to sinus rhythm or to prevent recurrence of Atrial Flutter once sinus rhythm was established. The past 25 years have produced major changes. A series of studies has advanced our understanding of the mechanism(s) of Atrial Flutter. Old techniques to diagnose Atrial Flutter have been significantly refined, and new diagnostic techniques have been developed. Beginning with the advent of DC cardioversion in the 1960s, major advances in the treatment of Atrial Flutter have occurred. β Blockers and calcium channel blockers are now available for use as an adjunct to or in lieu of digitalis treatment to control the ventricular response rate. New antiarrhythmic agents are available for use to suppress Atrial Flutter or convert it to sinus rhythm. Atrial pacing techniques to interrupt or suppress Atrial Flutter have evolved. Catheter ablation techniques either to cure Atrial Flutter or to control the ventricular response rate have been developed, and related surgical treatments are available. Even automatic low energy cardioversion of Atrial Flutter to sinus rhythm has been developed. Most of the advances in our understanding of Atrial Flutter have come from our understanding its mechanism. There is a long history, summarised recently,1 of studies in animal models which have contributed to our understanding of Atrial Flutter. While those studies have been and continue to be most helpful, a series of studies in patients—principally …

  • Pathogenesis of Atrial Flutter
    Journal of Cardiovascular Electrophysiology, 1998
    Co-Authors: Albert L Waldo
    Abstract:

    It is now known that most cases of Atrial Flutter are due to reentrant excitation in the right atrium. In the usual reentrant circuit, the reentrant excitation wavefront travels up the interAtrial septum and down the right Atrial free wall. The boundaries of this reentrant circuit include on one side the tricuspid valve ring and on the other side an area of block, which is probably functional, in the region between the venae cavae. The latter area of block forms during the transitional Atrial fibrillation rhythm of variable duration that almost always precedes the initiation of Atrial Flutter. An isthmus of conduction is also present in the reentrant circuit, and is bounded by the tricuspid ring and the inferior vena cava, the Eustachian ridge, and the coronary sinus. It is probable that an abnormal Atrial tissue substrate is usually required. Reentrant circuits around a surgical incision in the atria or around the pulmonary veins (in whole or in part) may be also responsible for Atrial Flutter.

Hugh Calkins - One of the best experts on this subject based on the ideXlab platform.

  • Catheter ablation of Atrial Flutter and macroreentrant Atrial tachycardia
    Current Opinion in Cardiology, 2020
    Co-Authors: Richard Wu, Ronald D. Berger, Hugh Calkins
    Abstract:

    Catheter ablation has evolved from an experimental technique to first-line therapy for the treatment of Atrial Flutter. Atrial Flutter is characterized by a macroreentrant Atrial tachycardia circuit. Successful ablation of Atrial Flutter involves (1) mapping the Atrial Flutter to define the conducti

  • Catheter Ablation of Atrial Flutter and Atrial Fibrillation
    Management of Cardiac Arrhythmias, 2010
    Co-Authors: Joseph E. Marine, Hugh Calkins
    Abstract:

    Atrial Flutter and Atrial fibrillation are two of the most common arrhythmias seen in clinical practice and the most common indications for referral for catheter ablation. While they are historically grouped together, research over the past 20 years has shown that Atrial Flutter and Atrial fibrillation are distinct arrhythmias with different electrophysiological mechanisms. This review will consider the development of and current approach to catheter ablation of Atrial Flutter and Atrial fibrillation.

  • Results of catheter ablation of typical Atrial Flutter
    American Journal of Cardiology, 2004
    Co-Authors: Hugh Calkins, Robert C. Canby, Raul Weiss, Gregg Taylor, Peter Wells, Larry Chinitz, Simon Milstein, Steven Compton, Kimberly Oleson, Lou Sherfesee
    Abstract:

    Abstract The purpose of this study was to evaluate the safety and efficacy of radiofrequency (RF) ablation of typical Atrial Flutter by using an 8-mm electrode catheter and a 100-W RF power generator. A limitation of previous trials of catheter ablation of Atrial Flutter is that the data were not collected as part of a prospective multicenter clinical trial. The study results associated catheter ablation of typical Atrial Flutter in a cohort of 150 patients with an 88% acute efficacy rate. At 6-month follow-up, recurrent typical Atrial Flutter was observed in 13% of patients. Of the 12 patients with typical Atrial Flutter recurrence, 4 were symptomatic and 8 were asymptomatic. Procedure duration was a significant predictor of typical Atrial Flutter recurrence. The 12-month rate for development of Atrial fibrillation was 30%. Catheter ablation of Atrial Flutter was associated with significant improvements in 5 of 8 domains of the Short Form 36 Survey (quality of life) and significant decreases in 13 of the 16 symptoms of the Symptom Checklist. The device- or procedure-related complication rate was 2.7%. Skin burns occurred at the dispersive pad site due to stronger RF power in 3 patients. Use of a dual dispersive pad system mitigated this problem. Thus, the results of this study associated catheter ablation of Atrial Flutter with high acute efficacy, a small risk of recurrent Atrial Flutter, and an important risk of Atrial fibrillation during follow-up.

  • Radiofrequency Catheter Ablation for Atrial Flutter
    NEJM Journal Watch, 1995
    Co-Authors: Hugh Calkins
    Abstract:

    Radiofrequency catheter ablation is safe and effective for accessory pathways and AV nodal reentrant tachycardia, but less is known about this procedure for Atrial Flutter. Atrial Flutter refractory to medical management had been present for a mean of five years in this …

  • catheter ablation of Atrial Flutter using radiofrequency energy
    American Journal of Cardiology, 1994
    Co-Authors: Hugh Calkins, Angel Leon, Gregory A Deam, Steven J Kalbfleisch, Jonathan J Langberg
    Abstract:

    Abstract Sixteen patients with type I Atrial Flutter underwent an attempt at radiofrequency catheter ablation (8 women, 8 men, mean age 53 ± 11 years). The primary criterion used to identify sites for radiofrequency energy delivery was the identification of a fractionated electrogram. Radiofrequency energy was delivered for 20 to 30 seconds. Radiofrequency catheter ablation was acutely successful in 13 patients and unsuccessful in 3. During a mean follow-up of 10 ± 4 months, 9 of 13 patients with a successful acute result (69%) remained free of recurrent Atrial Flutter or Atrial fibrillation. The ability to induce nonclinical types of Atrial Flutter was associated with an unsuccessful outcome. A greater proportion of electrograms recorded at successful sites demonstrated electrogram stability compared with unsuccessful ablation sites. None of the electrograms recorded at successful ablation sites were fractionated or had a double potential. This study demonstrates that radiofrequency catheter ablation of type I Atrial Flutter can be achieved safely.

Brian Olshansky - One of the best experts on this subject based on the ideXlab platform.

  • Thromboembolism in chronic Atrial Flutter : Is the risk underestimated?
    Journal of the American College of Cardiology, 1997
    Co-Authors: Charles Lanzarotti, Brian Olshansky
    Abstract:

    Abstract Objectives. We sought to evaluate the risk of thromboembolic events in the presence of chronic Atrial Flutter and to determine the impact of anticoagulation therapy, if any, on this risk. Background. Thromboembolic events are thought to be rare after cardioversion of Atrial Flutter. Methods. This study was a retrospective analysis of 110 consecutive patients referred to the electrophysiology laboratory for cardioversion of chronic Atrial Flutter from 1986 to 1996. Atrial Flutter was present for at least 6 months. Of the 110 patients reviewed, 100 had adequate information available regarding the effectiveness of anticoagulation (mean age 64 years, range 27 to 86; 75 men, 25 women; mean left ventricular ejection fraction 42%). Results. Thirteen patients (13%) had a thromboembolic event. Of these, seven were attributable to causes other than Atrial Flutter. In the remaining six patients (6%), thromboembolic events occurred during a rhythm of Atrial Flutter or after cardioversion to sinus rhythm. Other causes of thromboembolism were excluded. Effective anticoagulation was associated with a decreased risk of thromboembolism (p = 0.026). Conclusions. Patients with chronic Atrial Flutter are at an increased risk of thromboembolic events. Effective anticoagulation may decrease this risk.

  • Atrial Flutter—Update on the Mechanism and Treatment
    Pacing and Clinical Electrophysiology, 1992
    Co-Authors: Brian Olshansky, David J. Wilber, Robert J. Hariman
    Abstract:

    Atrial Flutter is a common and usually benign but symptomatic supraventricular tachycardia. There is a striking similarity between patients with Atrial Flutter suggesting a common substrate despite the presence or absence of underlying heart disease. In man, the mechanism is a single reentrant circuit originating in the right atrium whose center appears to be functional within the anatomical constraints of the right atrium. The reentrant circuit of Atrial Flutter contains an area of slow conduction in the inferior right atrium but the size and exact location is uncertain. Drug therapy directed at terminating and preventing Atrial Flutter has been available for many years. The efficacy and safety of this therapy is not as well tested as is the same therapy for Atrial fibrillation. The most effective way to terminate Atrial Flutter is a nonpharmacological approach. Several nonpharmacological methods provide new treatment options in the management of patients with drug resistant or hemodynamically unstable Atrial Flutter. The use of anticoagularion for this disorder is still evolving. There is a risk of clinically apparent thromboemboli in some patients with Atrial Flutter although the risk appears less than that for utrial fibrillation. In the future, refinements and improvements in therapy for Atrial Flutter will likely be derived from a better understanding of its mechanism.

  • demonstration of an area of slow conduction in Atrial Flutter
    Journal of the American College of Cardiology, 1990
    Co-Authors: Albert L Waldo, Ken Okumura, Brian Olshansky, Paul G Hess
    Abstract:

    Abstract Ten patients with chronic Atrial Flutter were studied prospectively using electrophysiologic mapping and pacing techniques to assess the mechanism of Atrial Flutter and the presence of an area of slow conduction in the atria. Electrograms recorded from ≥30 right Atrial sites for each patient during Atrial Flutter demonstrated that right Atrial free wall activation was craniocaudal and that the interAtrial septum activation was caudocranial, consistent with a reentrant circuit involving the right atrium. In six patients, slow conduction occurred during Atrial Flutter in the inferior right atrium and was spatially associated with fractionated electrographic recordings. In the other four patients, a “missing” interval of electrical activity occurred in the inferior right atrium for an average of 40% of the Atrial Flutter cycle. Transient entrainment criteria were demonstrated in each patient during rapid high right Atrial pacing. The mean activation time from the high right Atrial pacing site to the coronary sinus (inferior left Atrial) recording site was long (228 ms) and consistent with activation through an area of slow conduction. During rapid pacing of Atrial Flutter from the coronary sinus site, no transient entrainment criteria could be demonstrated. The mean activation time from the coronary sinus pacing site to the high right Atrial recording site was relatively short (134 ms) and consistent with orthodromic activation of the high right atrium not through an area of slow conduction. High right Atrial pacing during sinus rhythm at rates similar to Atrial Flutter demonstrated a short activation time to the coronary sinus and low right Atrial sites (mean 169 and 88 ms, respectively), indicating activation that did not traverse an area of slow conduction. Coronary sinus pacing during sinus rhythm demonstrated the same phenomena. Low right Atrial electrograms recorded during sinus rhythm and during rapid pacing of sinus rhythm were not fractionated, although they were during Atrial Flutter. Thus, Atrial mapping and pacing data were complementary, indicating that human Atrial Flutter in the patients studied was generated by a reentrant circuit in the right atrium, with an area of slow conduction in the low right atrium present only during Atrial Flutter.

Salimah Z Shariff - One of the best experts on this subject based on the ideXlab platform.

  • elevated incidence of Atrial fibrillation and stroke in patients with Atrial Flutter a population based study
    Canadian Journal of Cardiology, 2018
    Co-Authors: Lorne J Gula, Damian P Redfearn, Krista Bray Jenkyn, Britney Allen, Allan C Skanes, Peter Leongsit, Salimah Z Shariff
    Abstract:

    Abstract Background The risk of stroke from Atrial Flutter and its relationship with progression to Atrial fibrillation (AF) is unclear. This study describes the incidence of AF and stroke in patients with Atrial Flutter, and whether Atrial Flutter ablation attenuates the incidence of AF and stroke. Methods We performed a population-based retrospective cohort study of adults with typical Atrial Flutter with no AF history. Using linked health administrative databases we defined three cohorts: 1. adult patients diagnosed with new isolated Atrial Flutter; 2. a contemporary, one-to-one matched, cohort from the Ontario population; 3. patients with isolated Atrial Flutter who underwent Atrial Flutter ablation. Results A total of 9,339 new typical Atrial Flutter patients were identified and 7,248 were matched to general population subjects. Over the three-year follow-up, AF occurred in 40.4% of patients with Atrial Flutter, and 3.3% of the matched general population (rate ratio 12.2; p Conclusions Patients with isolated Atrial Flutter develop Atrial fibrillation and stroke at a higher rate than the general population. Catheter ablation reduces but does not eliminate future AF incidence and stroke risk and continued anticoagulation after successful Atrial Flutter ablation may therefore be warranted.

Jonathan J Langberg - One of the best experts on this subject based on the ideXlab platform.

  • catheter ablation of Atrial Flutter using radiofrequency energy
    American Journal of Cardiology, 1994
    Co-Authors: Hugh Calkins, Angel Leon, Gregory A Deam, Steven J Kalbfleisch, Jonathan J Langberg
    Abstract:

    Abstract Sixteen patients with type I Atrial Flutter underwent an attempt at radiofrequency catheter ablation (8 women, 8 men, mean age 53 ± 11 years). The primary criterion used to identify sites for radiofrequency energy delivery was the identification of a fractionated electrogram. Radiofrequency energy was delivered for 20 to 30 seconds. Radiofrequency catheter ablation was acutely successful in 13 patients and unsuccessful in 3. During a mean follow-up of 10 ± 4 months, 9 of 13 patients with a successful acute result (69%) remained free of recurrent Atrial Flutter or Atrial fibrillation. The ability to induce nonclinical types of Atrial Flutter was associated with an unsuccessful outcome. A greater proportion of electrograms recorded at successful sites demonstrated electrogram stability compared with unsuccessful ablation sites. None of the electrograms recorded at successful ablation sites were fractionated or had a double potential. This study demonstrates that radiofrequency catheter ablation of type I Atrial Flutter can be achieved safely.