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Focal intra-cavotricuspid isthmus atrial tachycardias occurring after typical atrial flutter ablation: incidence and electrocardiographic and electrophysiological characteristics

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Abstract

Purpose

Focal atrial tachycardias (ATs) from the septal cavotricuspid isthmus (CTI) occurring after successful CTI ablation can mimic typical atrial flutter (tAFL). This study investigated the incidence, and electrocardiographic and electrophysiological characteristics of these ATs.

Methods

Among 1082 consecutive patients undergoing successful CTI ablation without any congenital heart diseases, 7 were diagnosed with focal ATs originating from the septal CTI that occurred a median of 74 days after the CTI ablation.

Results

The electrocardiographic characteristics of the ATs were similar to those of the tAFLs. The AT’s cycle length was never shorter than and often similar to that of tAFLs. The activation patterns along the tricuspid annulus during the ATs were the same as those of tAFLs in 4 patients with foci adjacent to the CTI line, and centrifugal from foci around the coronary sinus (CS) ostium in 3. Entrainment pacing from the lateral CTI during the ATs revealed a manifest fusion and long post-pacing interval. Entrainment pacing from the lateral CTI during the ATs revealed that the atrial electrograms recorded from the CS and high-lateral right atrium were orthodromically captured, while that from the proximal CS revealed that the atrial electrograms recorded from the CS and lateral right atrium were antidromically captured without manifest fusion.

Conclusions

Focal intra-CTI ATs with a microreentrant mechanism very rarely occurred after successful CTI ablation. The electrocardiographic and electrophysiological characteristics of these ATs were similar to those of tAFLs. Overdrive pacing from the lateral CTI and proximal CS was helpful for distinguishing these ATs from recurrent tAFLs.

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Author information

Authors and Affiliations

  1. Division of Cardiovascular Disease, University of Alabama at Birmingham, FOT 930A, 510 20th Street South, Birmingham, AL, 35294-0019, USA

    Taihei Itoh & Takumi Yamada

  2. Department of Cardiology, Nagoya Dai-ni Red Cross Hospital, Nagoya, Japan

    Yukihiko Yoshida

  3. Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan

    Itsuro Morishima

Authors
  1. Taihei Itoh
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  2. Yukihiko Yoshida
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  3. Itsuro Morishima
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  4. Takumi Yamada
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Corresponding author

Correspondence to Takumi Yamada.

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The institutional review board approved the study protocol, and written informed consent was obtained from all patients before the study.

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Itoh, T., Yoshida, Y., Morishima, I. et al. Focal intra-cavotricuspid isthmus atrial tachycardias occurring after typical atrial flutter ablation: incidence and electrocardiographic and electrophysiological characteristics. J Interv Card Electrophysiol 52, 237–245 (2018). https://doi.org/10.1007/s10840-018-0359-6

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  • DOI: https://doi.org/10.1007/s10840-018-0359-6

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