![]() An Atrial Flutter AblationĪn atrial flutter ablation will generally take around 1 hour and patients can either be given ‘twilight sedation’ to keep them comfortable or a general anaesthetic. Some patients may have both atrial flutter and a related rhythm called atrial fibrillation (AF) at different times (see the section on 'Atrial Fibrillation'). This is because the success rates with atrial flutter ablation are ≥95% with a single procedure (substantially more effective than medications). In patients with symptoms from atrial flutter an ablation procedure is considered first line treatment. For this reason an anticoagulant or ‘blood thinner’ is often recommended to reduce the risk of blood clots and stroke. ![]() In atrial flutter the top chambers of the heart beat so quickly that they do not effectively pump blood and blood clots can develop. Symptoms and TreatmentĪtrial flutter may cause a persons heart rate to be increased (tachycardia) and can lead to symptoms such as palpitations (the sometimes unpleasant awareness of a persons heart beat), shortness of breath, dizziness, chest pain or sometimes lethargy. ![]() This causes the atria (the hearts upper chambers) to beat at around 300 beats per minute and commonly every second impulse travels down to the ventricles to cause a heart rate of 150 beats per minute (medications may be used to slow these heart rates down). Electroanatomic mapping was a powerful tool both for identification of different atrial re-entrant circuits including their critical isthmuses as well as for effective application of individual ablation line strategies.Atrial flutter is a short circuit where electrical activity travels in a continuous loop around the tricuspid valve/annulus on the right hand side of the heart. ![]() In conclusion, conventional pacing in the cavotricuspid isthmus combined with electroanatomic mapping was an effective method to differentiate between typical and atypical atrial flutter. There was no incidence of serious complications associated with these procedures. Mean duration time of the procedure was 235.6 +/- 56.4 min (right atrium: 196 +/- 17.3 min left atrium: 267.2 +/- 59.5 min), and average fluoroscopy time was 21.8 +/- 11.7 min (right atrium: 9.5 +/- 6 min left atrium: 28.9 +/- 7 min). Another patient developed permanent atrial fibrillation shortly after the procedure. After a mean follow-up of 8.8 +/- 3.4 months, there was one patient with a recurrence of left-sided atrial flutter. This arrhythmia required ablation of those distinct isthmuses to be interrupted. One patient, after surgical closure of a ventricular septal defect, demonstrated a dual-loop intra-atrial reentry tachycardia dependent on two different isthmuses. In the remaining cases, ablation was acutely successful. In 1 patient, the investigation was stopped due to variable ECG pattern and atrial cycle lengths. In these patients targets for ablation lines were located between silent areas and anatomic barriers (inferior pulmonary veins, mitral respectively tricuspid annulus, or vena cava inferior). Electrically silent ("low voltage") areas probably demonstrating atrial myopathy were identified in all cases with left sided and in 2 patients with right sided flutter. Atypical flutter was right sided in 4 patients and left sided in 7 cases. Therefore, entrainment pacing was able to predict the true presence of typical atrial flutter in 91.5%. We performed electroanatomic mapping in the remaining 17 patients (14 male age 60.9 +/- 16 years) resulting in the identification of 6 cases with typical and 11 cases with atypical flutter. Conventional ablation of the right atrial isthmus was successful in all patients (n = 54) with positive entrainment. As a consequence of negative entrainment we performed 3D-electroanatomic activation mapping (CARTO trade mark ). In patients with positive entrainment we considered the arrhythmia as typical flutter and treated them with conventional ablation of the cavotricuspid isthmus. Between August 2001 and June 2003, we performed conventional entrainment pacing within the cavotricuspid isthmus in 71 patients with sustained atrial flutter. However, successful ablation of atrial flutter depends on the exact identification of the responsible re-entrant circuit and its critical isthmus. Differentiation between typical and atypical atrial flutter solely based upon surface ECG pattern may be limited.
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