Electrophysiological anatomy of typical atrial flutter: The posterior boundary and causes for difficulty with ablation

Apoor S. Gami, William D. Edwards, Nirusha Lachman, Paul Andrew Friedman, Deepak Talreja, Thomas M. Munger, Stephen C. Hammill, Douglas L Packer, Samuel J Asirvatham

Research output: Contribution to journalArticle

35 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)144-149
Number of pages6
JournalJournal of Cardiovascular Electrophysiology
Volume21
Issue number2
DOIs
StatePublished - Feb 2010

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Atrial Flutter
Anatomy
Muscles
Coronary Sinus
Heart Atria

Keywords

  • Ablation
  • Atrial flutter
  • Cavotricuspid isthmus
  • Crista terminalis
  • Pectinate muscle
  • Right atrium

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Electrophysiological anatomy of typical atrial flutter : The posterior boundary and causes for difficulty with ablation. / Gami, Apoor S.; Edwards, William D.; Lachman, Nirusha; Friedman, Paul Andrew; Talreja, Deepak; Munger, Thomas M.; Hammill, Stephen C.; Packer, Douglas L; Asirvatham, Samuel J.

In: Journal of Cardiovascular Electrophysiology, Vol. 21, No. 2, 02.2010, p. 144-149.

Research output: Contribution to journalArticle

Gami, Apoor S. ; Edwards, William D. ; Lachman, Nirusha ; Friedman, Paul Andrew ; Talreja, Deepak ; Munger, Thomas M. ; Hammill, Stephen C. ; Packer, Douglas L ; Asirvatham, Samuel J. / Electrophysiological anatomy of typical atrial flutter : The posterior boundary and causes for difficulty with ablation. In: Journal of Cardiovascular Electrophysiology. 2010 ; Vol. 21, No. 2. pp. 144-149.
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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.",
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