Drs. Yang and Ju contributed equally to this work.
Comparison of the Location of Slow Conduction Velocity in Cavotricuspid-Dependent Atrial Flutter in Patients With and Without Prior Atriotomy: Different Arrhythmogenic Basis and Clinical Implications for Placement of Atriotomy
Article first published online: 7 AUG 2012
© 2012 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 23, Issue 9, pages 988–995, September 2012
How to Cite
YANG, B., JU, W., CHEN, H., ZHANG, F., CHEN, K., GU, K., CAO, K. and CHEN, M. (2012), Comparison of the Location of Slow Conduction Velocity in Cavotricuspid-Dependent Atrial Flutter in Patients With and Without Prior Atriotomy: Different Arrhythmogenic Basis and Clinical Implications for Placement of Atriotomy. Journal of Cardiovascular Electrophysiology, 23: 988–995. doi: 10.1111/j.1540-8167.2012.02348.x
This study was supported by the Program for Development of Innovative Research Team in the First Affiliated Hospital of Nanjing Medical University, P.R. China (IRT-004).
- Issue published online: 18 SEP 2012
- Article first published online: 7 AUG 2012
- Manuscript received 9 Janruary 2012; Revised manuscript received 20 February 2012; Accepted for publication 28 February 2012.
- atrial flutter;
- conduction velocity;
- cardiac surgery;
- catheter ablation;
- electroanatomic mapping
Slow Zone in CTI-Dependent Flutter After Atriotomy. Introduction: Earlier studies have shown that the slow conduction zone in patients with cavotriscuspid (CTI)-dependent atrial flutter without prior surgery (NS-AFL) is the CTI. However, the location of this slow zone in patients with CTI-dependent flutter and a prior atriotomy has not been formally studied. Identification of the slow zone in patients with prior atriotomy and CTI-dependent atrial flutter (PA-AFL) and comparison with NS-AFL may have important clinical implications.
Methods and Results: Seventeen consecutive patients with PA-AFL and 17 consecutive patients with NS-AFL were included. Conduction velocity (CV) was measured using 3-dimensional mapping in 3 areas around the TVA. These regions were defined as the CTI area from lateral inferior vena cava orifice to coronary sinus ostium (region I), mid- to upper-septum (S), and free wall (F). In region F, the CV was much slower in PA-AFL than in NS-AFL patients (0.43 ± 0.13 vs 0.76 ± 0.26 m/s, P < 0.01). However, region I was slower in NS-AFL than PA-AFL (0.57 ± 0.18 m/s vs 0.84 ± 0.24 m/s, P < 0.01). In all PA-AFL patients, the slow zone was in region F. But in most (11/17) NS-AFL patients the slow zone was in region I. There was no significant difference in CV in region S between the 2 groups.
Conclusions: Unlike NS-AFL, CTI in PA-AFL displays relatively normal conduction but the slow zone is on the free wall. This arrhythmogenecity of atriotomy may perhaps be avoided if the incisional line were altered to extend to the TV. (J Cardiovasc Electrophysiol, Vol. 23, pp. 988-995, September 2012)