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CLINICAL STUDY

Characterization of the anatomy and conduction velocities of the human right atrial flutter circuit determined by noncontact mapping

Richard J. Schilling, MD^a, Nicholas S. Peters, MD^a, Jeffrey Goldberger, MD, Alan H. Kadish, MD and D. Wyn Davies, MD^a

^a St. Mary’s Hospital and Imperial College School of Medicine, London, United Kingdom
Northwestern Memorial Hospital, Chicago, Illinois, USA

Manuscript received January 15, 2000; revised manuscript received March 1, 2001, accepted April 23, 2001.

Reprint requests and correspondence: Dr. Richard Schilling, Waller Department of Cardiology, St. Mary’s Hospital, Praed St., London W2 1NY, United Kingdom
r.schilling{at}ic.ac.uk

OBJECTIVES

This study was done to characterize human right atrial (RA) flutter (AFL) using noncontact mapping.

BACKGROUND

Atrial flutter has been mapped using sequential techniques, but complex anatomy makes simultaneous global RA mapping difficult.

METHODS

Noncontact mapping was used to map the RA of 13 patients with AFL (5 with previous attempts), 11 with counterclockwise and 2 with clockwise AFL. "Reconstructed" electrograms were validated against contact electrograms using cross-correlation. The Cartesian coordinates of points on a virtual endocardium were used to calculate the length and thus the conduction velocity (CV) of the AFL wave front within the tricuspid annulus-inferior vena cave isthmus (IS) and either side of the crista terminalis (CT).

RESULTS

When clearly seen, the AFL wave front split (n = 3) or turned in the region of the coronary sinus os (n = 6). Activation progressed toward the tricuspid annulus (TA) from the surrounding RA in 10 patients, suggesting that the leading edge of the reentry wave front is not always at the TA. The IS length and CV was 47.73 ± 24.40 mm (mean ± SD) and 0.74 ± 0.36 m/s. The CV was similar for the smooth and trabeculated RA (1.16 ± 0.48 m/s and 1.22 ± 0.65 m/s, respectively [p = 0.67]) and faster than the IS (p = 0.03 and p = 0.05 for smooth and trabeculated, respectively).

CONCLUSIONS

Noncontact mapping of AFL has been validated and has demonstrated that IS CV is significantly slower than either side of the CT.

Abbreviations and Acronyms   AFL = atrial flutter   ASD = atrial septal defect   CI = confidence interval   CS = coronary sinus   CT = crista terminalis   CV = conduction velocity   ECG = electrocardiograms   IS = tricuspid annulus-inferior vena cava isthmus   IVC = inferior vena cava   LAO = left anterior oblique   MEA = multielectrode array   RA = right atrium/atrial   SVC = superior vena cava   TA = tricuspid annulus

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