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ARRHYTHMIAS

Non-contact mapping to guide radiofrequency ablation of atypical right atrial flutter

Division of Cardiology, Department of Medicine, National Yang-Ming University School of Medicine, Taipei Veterans General Hospital, Taiwan, Republic of China

Manuscript received April 11, 2004; revised manuscript received May 13, 2004, accepted May 18, 2004.

^* Reprint requests and correspondence: Dr. Ching-Tai Tai, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan (Email: ct.tai{at}msa.hinet.net).

OBJECTIVES: This study was aimed at evaluating the efficacy of non-contact mapping and ablation of non-incisional atypical right atrial (RA) flutters.

BACKGROUND: The majority of atypical RA flutters were reported in patients after surgical incision of the RA.

METHODS: The study group consisted of 15 patients (61 ± 13 years, 8 males) with atypical atrial flutter (AFL). The RA activation during AFL was delineated using a non-contact mapping system (EnSite 3000 with Precision Software, Endocardial Solutions, St. Paul, Minnesota). The narrowest part of each reentrant circuit was targeted using radiofrequency energy.

RESULTS: In all 15 patients, non-contact mapping showed AFLs confined to the RA with RA activation time accounting for 100% of the cycle length (210 ± 19 ms). During single-loop re-entry in seven patients, the activation wave front circulated around the central obstacle (CO) in the anterolateral wall with conduction through the channel between the CO and the crista terminalis (CT). During figure-of-eight re-entry in eight patients, simultaneous upper and lower loop re-entry through the conduction gap in the CT was found in four patients, and simultaneous upper loop and free-wall single-loop re-entry was observed in four patients. Radiofrequency ablation of the free-wall channel and/or CT gap was effective in eliminating these AFLs in 13 patients. During a follow-up of 16.8 ± 3.8 months, two patients had recurrence of left AFL, and one had recurrence of atrial fibrillation.

CONCLUSIONS: Atypical RA flutters could arise from single-loop or double-loop figure-of-eight re-entry. Radiofrequency ablation of the free-wall channel and/or the CT gap was effective in eliminating these arrhythmias.

Abbreviations and Acronyms   AFL = atrial flutter   CO = central obstacle   CS = coronary sinus   CT = crista terminalis   CTI = cavotricuspid isthmus   IVC = inferior vena cava   MEA = multi-electrode array   RA = right atrial/atrium   RF = radiofrequency   SVC = superior vena cava

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