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Conduction Properties of the Crista Terminalis in Patients with Typical Atrial Flutter: Basis for a Line of Block in the Reentrant Circuit
Author(s) -
TAT CHINGTAI,
CHEN SHIHANN,
CHEN YIJEN,
YU WENCHUNG,
HSIEH MINGHSIUNG,
TSAI CHINFENG,
CHEN CHIENCHENG,
DING YUAN,
CHANG MAUSONG
Publication year - 1998
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.1998.tb00120.x
Subject(s) - crista terminalis , atrial flutter , medicine , sinus rhythm , crista , cardiology , atrial tachycardia , anatomy , catheter ablation , atrial fibrillation , biology , mitochondrion , microbiology and biotechnology
Conduction Properties of the Crista Terminalis . Introduction : Previous mapping studies in patients with typical atrial flutter have demonstrated the crista terminalis to he a posterior harrier of the reentrant circuit forming a line of block. However, the functional role of the crista terminalis in patients with or without a history of atrial flutter is not well known. The aim of this study was to determine whether the conduction properties of the crista terminalis are different between patients with and those without a history of atrial flutter. Methods and Results : The study population consisted of 12 patients with clinically documented atrial flutter (group 1) and 12 patients with paroxysmal supraventricular tachycardia as well as induced atrial flutter (group 2). A 7‐French, 20‐pole, deflectable Halo catheter was positioned around the tricuspid annulus. A 7‐French, 20‐pole Crista catheter was placed along the crista terminalis identified by the recording of double potentials with opposite activation sequences during typical atrial flutter. After sinus rhythm was restored, pacing from the low posterior right atrium near the crista terminalis was performed at multiple cycle length to 2:1 atrial capture. No double potentials were recorded along the crista terminalis during sinus rhythm in both groups. In group 1, the longest pacing cycle length that resulted in a line of block with double potentials along the crista terminalis was 638 ± 119 msec. After infusion of propranolol, it was prolonged to 832 ± 93 msec without change of the interdeflection intervals of double potentials. In group 2, the longest pacing cycle length that resulted in a line of block with double potentials along the crista terminalis was 214 ± 23 msec. After infusion of procainamide, it was prolonged to 306 ± 36 msec with increase of interdeflection interval of double potentials. Conclusion : The crista terminalis forms a line of transverse conduction block during typical atrial flutter. Poor transverse conduction property in the crista terminalis may be the requisite substrate for clinical occurrence of typical atrial flutter.