Atrial Flutter ; Fetus ; Humans

Atrial flutter, a common rhythm disturbance, was first described over 80 years ago. Despite extensive investigations, several important issues remain unresolved concerning its exact mechanism and management. Present therapeutic strategies often appear effective to prevent and terminate atrial flutter. However, controlled trial and definitive studies comparing the various treatment options are surprisingly scarce. Here we report on a study of 9 episodes of spontaneous atrial flutter(AF)(flutter wave cycle length 224+/-39 msec) treatedd by transesophageal atrial pacing(TAP) in 9 patients(7 men and 2 women; mean age 56.9 yrs). TAP was effective in 5 patients : sinus rhythm resumption was immediate in 3 patients and followed a short period of atrial fibrillation in 2 patients. TAP was unsuccessful in 4 patients. All the patients tolerated the procedure well. These data strongly support the immediate first choice use of TAP in AF therapy.
Atrial Fibrillation ; Atrial Flutter* ; Female ; Humans ; Male

Atrial flutter is a macro-reentrant atrial arrhythmia characterized by regular atrial rate and constant P-wave morphology. The atrial flutter is divided into typical and atypical types, according to whether reentrant circuit involves the cavotricuspid isthmus. This review summarizes the management of atrial flutter based on 2015 ACC/AHA/HRS guideline.
Arrhythmias, Cardiac ; Atrial Flutter* ; Catheter Ablation

Arrhythmias, Cardiac ; Atrial Flutter/diagnosis* ; Electrocardiography ; Humans

No abstract available.
Arrhythmias, Cardiac ; Atrial Flutter ; Lymphoma ; Tachycardia, Ventricular

Humans ; Atrial Fibrillation ; Atrial Flutter ; Lung Transplantation/adverse effects*

BACKGROUND AND OBJECTIVES: Local wide split double potentials are used as a parameter to determine complete conduction block during cavotricuspid isthmus ablation in patients with isthmus dependent atrial flutter. However, delayed slow conduction in that region can sometimes be very difficult to differentiate from complete block. Flutter cycle length (FCL) can be used to confirm isthmus conduction block, because FCL is a measure of conduction time around the tricuspid annulus (TA). This study was designed to determine which degree of splitting of the local electrograms is adequate to confirm complete isthmus block, using FCL as a reference. SUBJECTS AND METHODS: Cavotricuspid isthmus (CTI) ablation was performed in fifty consecutive patients. The interval between the pacing stimulus on the lateral side of the CTI and the first component of the double potentials on the block line (SD1) corresponded to the counterclockwise conduction time. The interval between the pacing stimulus and second component (SD2) represented the clockwise conduction time to the contralateral side of the ablation line. SD1 and SD2 were measured before and after complete isthmus block. RESULTS: An SD1+SD2 reaching 90% of the FCL identified the counterclockwise isthmus conduction block with 94% sensitivity and 100% specificity. CONCLUSION: If the sum of SD1 and SD2 following isthmus ablation was close to the FCL, complete conduction block was predicted with high diagnostic accuracy and positive predictive value for at least counterclockwise conduction.
Atrial Flutter ; Catheter Ablation ; Humans ; Sensitivity and Specificity ; Syndactyly

BACKGROUND AND OBJECTIVES: The mechanism by which atrial fibrillation (AF) electrically converts to sinus rhythm remains undefined. The purpose of this study was to assess in detail the electrograms recorded during cardioversion using direct current (DC) shock. SUBJECTS AND METHODS: In 23 patients with AF (chronic n=20, paroxysmal n=3, M:F=15:8, 50 - 70 years old), electrograms were recorded simultaneously from a 20-pole electrode catheters (Duo-deca, DAIG) in the right atrial free wall and the coronary sinus immediately after DC shock given transthoracically. The activation patterns following 45 trials consisting of 23 successful and 22 unsuccessful cardioversion were analyzed. RESULTS: Two distinct patterns following successful cardioversion were observed; either immediate resumption of normal sinus rhythm (n=5, 21%), or one or two activations immediately after shock preceded normal sinus rhythm (n=18, 79%). The energy levels of the two patterns were not significantly different (260 J, 250 J, respectively). Four patterns following unsuccessful cardioversion were noted; unchanged (n=10, 45%), converted to atrial flutter (n=4, 18%), production of three or four beats of more coordinated complexes and reverted to AF (n=5, 22%), and converted to sinus rhythm transiently and reinitiated AF by one or two atrial premature beats (n=3, 13%). The magnitude of the DC shock applied at these 4 different patterns was 196 J, 240 J, 264 J, and 340 J, respectively in which low energy levels made a simultaneous depolarization of the entire atria unlikely. CONCLUSION: Distinct activation patterns were identified following successful and unsuccessful cardioversion using DC shock for AF. These observations suggest that total depolarization of the entire atria is not a prerequisite for the conversion of AF into sinus rhythm.
Atrial Fibrillation* ; Atrial Flutter ; Cardiac Complexes, Premature ; Catheters ; Coronary Sinus ; Electric Countershock* ; Electrodes ; Humans ; Shock

OBJECTIVETo determine the feasibility and efficiency of terminating atrial flutter (AFL) and atrial fibrillation (AF) using synchronous low-energy shocks delivered through a novel transesophageal electric balloon electrode system.

METHODSBy using a novel electric balloon electrode system, we attempted 91 transesophageal cardioversions in 52 patients, to treat 53 episodes of AFL and 38 episodes of AF.

RESULTSOf the 40 patients of AFL that failed to respond to drug therapy, 37 (92.5%) were successfully countershocked to sinus rhythm by transesophageal cardioversion, with a mean energy of (22.70 +/- 4.50) J (20 - 30 J). Of the 19 patients in AF, transesophageal cardioversion was successful in 16 (84.2%) cases, requiring a mean delivered energy of (17.38 +/- 8.58) J (3 - 30 J). There were no complications such as heart block or ventricular fibrillation, and no evidence of esophageal injury.

CONCLUSIONSTransesophageal cardioversion using an electric balloon electrode system is an effective and feasible method for the treatment of AFL and AF. It requires low energy and no anesthesia, leads to less trauma, and shows a high cardioversion success rate that may prove valuable in the management of tachyarrhythmias.

Atrial Fibrillation ; therapy ; Atrial Flutter ; therapy ; Electric Countershock ; instrumentation ; methods ; Electrodes ; Esophagus ; Humans ; Treatment Outcome

Atrial Flutter ; etiology ; Heart Aneurysm ; Heart Septal Defects, Atrial ; complications ; Humans ; Infant, Newborn ; Male