Abstract
Electrophysiological Anatomy of Typical Atrial Flutter. Background: The electrophysiological anatomy of cavotricuspid isthmus-dependent atrial flutter (CVTI-AFL) has not been fully elucidated. Methods: We studied 602 autopsied human hearts from individuals aged 0 to 103 years. We measured morphological features of the right atrium, including the crista terminalis (CT), pectinate muscles, sub-Eustachian pouch, Thebesian valve (TV), and the coronary sinus (CS) ostium. Results: In adults, the mean right atrium dimensions were 4.7 cm × 4.5 cm × 4.4 cm. Pectinate muscles extended medial to the CT in 54% of hearts. In 19% of hearts, these ended in another ridge termed the second CT. Pectinate muscles extended into the CVTI in 70% of hearts. A sub-Eustachian pouch was present in 16% of hearts, was always located on the septal CVTI, and was more likely when a prominent TV was also present. A TV, present in 62% of all hearts, covered the inferior quadrant of the CS ostium in 9% of these hearts. Conclusion: The posterior boundary of the reentrant circuit of CVTI-AFL comprises the Eustachian ridge and CT, but in some patients may also include a second CT. Sub-Eustachian pouches on the septal CVTI are strongly associated with a prominent TV. The lateral CVTI can have prominent pectinate muscles. This comprehensive characterization of the electrophysiological anatomy of the reentrant circuit of CVTI-AFL may provide guidance and improve success during difficult ablations.
Original language | English (US) |
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Pages (from-to) | 144-149 |
Number of pages | 6 |
Journal | Journal of cardiovascular electrophysiology |
Volume | 21 |
Issue number | 2 |
DOIs | |
State | Published - Feb 2010 |
Keywords
- Ablation
- Atrial flutter
- Cavotricuspid isthmus
- Crista terminalis
- Pectinate muscle
- Right atrium
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)