International journal of cardiology · 2013
Reentry mechanisms and ablation of ECG-typical atrial flutters involving the cavo-tricuspid isthmus and the proximal coronary sinus.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
De Sisti Antonio, Tonet Joelci, Márquez Manlio F, Amara Walid, Broustet Henri, Touil Faouzi, Hidden-Lucet Françoise
Аннотация
AIM: Reentry circuits of a rare typical atrial flutter (AFL) involving the cavo-tricuspid isthmus (CTI) and proximal coronary sinus (CS) are described based on electrophysiological data and effects of radiofrequency (RF).
METHODS AND RESULTS: Twelve patients with ECG-typical AFL in whom entrainment demonstrated that CTI and proximal CS were both part of the circuit were included. Initial RF target was CTI in 8 patients and proximal CS in 4. Success was defined as AFL termination/noninducibility. After CTI ablation, AFL cycle length (CL) increased in all: AFL persisted in 3, while in the other 5 AFL was interrupted but subsequently induced with the same morphology; before induction CTI bi-directional block was validated; success was obtained at the CS, targeting fragmented atrial potentials (APs). In those with first ablation at CS, AFL was interrupted in 3 with no AFL inducibility; in 1 AFL persisted with CL prolongation and was terminated at CTI. Two reentry patterns were identified: in 5 patients the inter-atrial septum as well as the mid-distal CS were outside of the circuit, while the CTI, proximal CS and Bachmann's bundle zone were inside, suggesting a left atrial component; in 1 patient electrophysiological mapping suggested an intra-CS circuit component. RF was successful in all without recurrence.
CONCLUSION: Electrophysiological mapping and RF effects suggest a continuum between the CTI and proximal CS in rare cases with ECG-typical AFL. RF inside the proximal CS, targeting fragmented APs, should be considered in any patient in whom CTI ablation failed to interrupt a typical AFL.
METHODS AND RESULTS: Twelve patients with ECG-typical AFL in whom entrainment demonstrated that CTI and proximal CS were both part of the circuit were included. Initial RF target was CTI in 8 patients and proximal CS in 4. Success was defined as AFL termination/noninducibility. After CTI ablation, AFL cycle length (CL) increased in all: AFL persisted in 3, while in the other 5 AFL was interrupted but subsequently induced with the same morphology; before induction CTI bi-directional block was validated; success was obtained at the CS, targeting fragmented atrial potentials (APs). In those with first ablation at CS, AFL was interrupted in 3 with no AFL inducibility; in 1 AFL persisted with CL prolongation and was terminated at CTI. Two reentry patterns were identified: in 5 patients the inter-atrial septum as well as the mid-distal CS were outside of the circuit, while the CTI, proximal CS and Bachmann's bundle zone were inside, suggesting a left atrial component; in 1 patient electrophysiological mapping suggested an intra-CS circuit component. RF was successful in all without recurrence.
CONCLUSION: Electrophysiological mapping and RF effects suggest a continuum between the CTI and proximal CS in rare cases with ECG-typical AFL. RF inside the proximal CS, targeting fragmented APs, should be considered in any patient in whom CTI ablation failed to interrupt a typical AFL.