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Electrophysiological Anatomy of Typical Atrial Flutter: The Posterior Boundary and Causes for Difficulty with Ablation
Author(s) -
GAMI APOOR S.,
EDWARDS WILLIAM D.,
LACHMAN NIRUSHA,
FRIEDMAN PAUL A.,
TALREJA DEEPAK,
MUNGER THOMAS M.,
HAMMILL STEPHEN C.,
PACKER DOUGLAS L.,
ASIRVATHAM SAMUEL J.
Publication year - 2010
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.1540-8167.2009.01607.x
Subject(s) - crista terminalis , medicine , anatomy , ostium , coronary sinus , atrial flutter , electrophysiology , ablation , pouch , atrium (architecture) , catheter ablation , cardiology , atrial fibrillation
Electrophysiological Anatomy of Typical Atrial Flutter.Background:The electrophysiological anatomy of cavotricuspid isthmus‐dependent atrial flutter (CVTI‐AFL) has not been fully elucidated.Methods:We studied 602 autopsied human hearts from individuals aged 0 to 103 years. We measured morphological features of the right atrium, including the crista terminalis (CT), pectinate muscles, sub‐Eustachian pouch, Thebesian valve (TV), and the coronary sinus (CS) ostium.Results:In adults, the mean right atrium dimensions were 4.7 cm × 4.5 cm × 4.4 cm. Pectinate muscles extended medial to the CT in 54% of hearts. In 19% of hearts, these ended in another ridge termed the second CT. Pectinate muscles extended into the CVTI in 70% of hearts. A sub‐Eustachian pouch was present in 16% of hearts, was always located on the septal CVTI, and was more likely when a prominent TV was also present. A TV, present in 62% of all hearts, covered the inferior quadrant of the CS ostium in 9% of these hearts.Conclusion:The posterior boundary of the reentrant circuit of CVTI‐AFL comprises the Eustachian ridge and CT, but in some patients may also include a second CT. Sub‐Eustachian pouches on the septal CVTI are strongly associated with a prominent TV. The lateral CVTI can have prominent pectinate muscles. This comprehensive characterization of the electrophysiological anatomy of the reentrant circuit of CVTI‐AFL may provide guidance and improve success during difficult ablations. (J Cardiovasc Electrophysiol, Vol. 21, pp. 144‐149, February 2010)