Correlative anatomy and electrophysiology for the interventional electrophysiologist: Right atrial flutter

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52 Citations (Scopus)

Abstract

Anatomy of Right Atrial Flutter. The cavotricuspid isthmus (CVTI) is the well-established location of atrial tissue critical for the maintenance of typical atrial flutter. The CVTI begins at the electrically inert tricuspid valve and includes the atrial myocardium up to the inferior vena cava (IVC). In this article, we discuss relevant CVTI and right atrial anatomy of interest to the electrophysiologist. Critical questions that are considered include why ablation is sometimes difficult across the CVTI and how best to deal with anatomic variation including sub-Eustachian pouches or large pectinate muscles encroaching onto the isthmus. Important electroanatomic features of the right atrium (RA) including sites for naturally occurring conduction block and the anatomy of the "lower loop" are reviewed. Following this discussion on the impact of the underlying anatomy for right atrial flutter ablation, an approach to dealing with difficulty when mapping or ablating this common arrhythmia is presented.

Original languageEnglish (US)
Pages (from-to)113-122
Number of pages10
JournalJournal of Cardiovascular Electrophysiology
Volume20
Issue number1
DOIs
StatePublished - Jan 2009

Fingerprint

Atrial Flutter
Electrophysiology
Anatomy
Anatomic Variation
Tricuspid Valve
Inferior Vena Cava
Heart Atria
Cardiac Arrhythmias
Myocardium
Maintenance
Muscles

Keywords

  • Ablation
  • Anatomy
  • Atrial flutter
  • Cavotricuspid isthmus
  • Crista terminalis
  • Electrophysiology
  • Typical flutter

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

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abstract = "Anatomy of Right Atrial Flutter. The cavotricuspid isthmus (CVTI) is the well-established location of atrial tissue critical for the maintenance of typical atrial flutter. The CVTI begins at the electrically inert tricuspid valve and includes the atrial myocardium up to the inferior vena cava (IVC). In this article, we discuss relevant CVTI and right atrial anatomy of interest to the electrophysiologist. Critical questions that are considered include why ablation is sometimes difficult across the CVTI and how best to deal with anatomic variation including sub-Eustachian pouches or large pectinate muscles encroaching onto the isthmus. Important electroanatomic features of the right atrium (RA) including sites for naturally occurring conduction block and the anatomy of the {"}lower loop{"} are reviewed. Following this discussion on the impact of the underlying anatomy for right atrial flutter ablation, an approach to dealing with difficulty when mapping or ablating this common arrhythmia is presented.",
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