Cases reported "Atrial Flutter"

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1/49. Radiofrequency catheter ablation of common atrial flutter: role of the eustachian valve.

    INTRODUCTION: During radiofrequency catheter ablation of a common atrial flutter between the tricuspid annulus and the Eustachian valve "septal isthmus", double potentials were recorded along the Eustachian valve, previously described as an anatomical line of conduction block between the coronary sinus ostium and the inferior vena cava. RESULTS: Just before flutter termination, lengthening and beat to beat delay variations between the 2 components of the double potentials were correlated with simultaneous modifications of the flutter cycle length. CONCLUSION: The "septal isthmus" is a common pathway for the flutter wavefront and the impulse generating the second component of the double potential. It is also a good target for flutter ablation.
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2/49. Microwave ablation of atrial flutter.

    Radiofrequency (RF) ablation of the isthmus between the inferior vena cava and the tricuspid ring has proven to be a safe and successful method of treating atrial flutter (AF). However, RF ablation lesions are small in size requiring a considerable number of energy applications to ablate the AF circuit. The aim of this study was to evaluate the feasibility and efficacy of microwave energy for AF ablation. We report a case of sustained typical AF treated successfully and safely by 1 pulse of microwave (MW) energy. This showed it is possible to treat AF with a small number of pulse applications.
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3/49. Implantable atrial defibrillator and detection of atrial flutter.

    The implantable atrial defibrillator (IAD) is designed to detect and treat atrial fibrillation (AF) with low energy synchronized shocks. A patient with a history of persistent AF was implanted with an IAD after ineffective treatment with procainamide and sotalol. Through four months of follow-up, the IAD performed appropriate detection and treatment of AF. During the fifth month, the patient was put on flecainide in an attempt to minimize the AF recurrence rate. On flecainide the patient experienced typical atrial flutter which required IAD reprogramming for appropriate detection and therapy delivery. This case report examines the optimization of the IAD to detect atrial flutter. Six months of follow-up after optimization the IAD has shown appropriate detection of both atrial flutter and AF. During the entire follow-up period the IAD had appropriate detection of sinus rhythm (no false positive detection, i.e. sinus rhythm as AF).
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4/49. ICD hardware failure associated with multiple internal shocks.

    The delivery of 37 shocks by an ICD within 20 minutes, in response to T wave oversensing during atrial flutter, resulted in several manifestations of undesirable device behavior. The generator reverted to backup mode, and disabled automatic capacitor reformation, therapy delivery, and automatic gain control. Postexplant analysis of the device revealed damage to the high voltage output section of the circuitry consistent with excessive electrical stress. In rare circumstances, multiple internal discharges can result in serious clinical anomalies in ICD behavior, and possibly in an increase in susceptibility to circuitry damage.
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5/49. Polycardiographic study of atrial flutter.

    The modifications that atrial flutter determines on the phonocardiogram, apexcardiogram, carotid pulse tracing, jugular venous pulse tracing, and indirect (esophageal) left atrial pulse tracing were studied. On the basis of the data here presented and that of the literature, a polygraphic profile of atrial flutter has been constructed as follows: notable variability of the intensity and of the richness of the vibratory components of the first and second heart sound; regularly alternating intervals between successive atrial sounds, each one of which consists of two groups of vibrations; deformations of all mechanographic tracings corresponding with "F" waves of the ECG. The interpretation of various polygraphic reports contributes to the understanding of the physiopathogenesis of atrial flutter.
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6/49. A peculiar form of focal atrial tachycardia mimicking atypical atrial flutter.

    A 55-year-old man was referred because of congestive heart failure and atrial flutter. A 12-lead electrocardiogram (ECG) showed positive P waves in leads II, III, and aVF with a continuously undulating pattern that lacked an isoelectric baseline. tachycardia was diagnosed as atypical atrial flutter based on classical criteria. An electrophysiological study and catheter ablation using an electroanatomical system revealed the mechanism of the tachycardia to be focal atrial tachycardia originating from the left atrial roof. This case indicates that focal atrial tachycardia may present as atypical atrial flutter on the surface ECG.
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7/49. atrial flutter in the recipient atrium induced by premature beats arising from the donor atrium 10 years after orthotopic heart transplantation.

    BACKGROUND: Several mechanisms for the genesis of supraventricular arrhythmias in patients after orthotopic heart transplantation have been reported. methods AND RESULTS: We describe a 58-year-old male patient in whom atrial flutter occurred 10 years after orthotopic heart transplantation. During an electrophysiological study, bidirectional conduction between the recipient and donor atria was found. atrial flutter in the recipient atrium was induced by programmed stimulation of the donor atrium using a single extrastimulus. The clinical symptoms were caused by atrial flutter arising from the recipient atrium with 1:1 to 3:1 conduction to the donor atrium. Mapping the anastomosis between the two atria indicated fragmented potentials at a discrete site of conduction. Delivery of radiofrequency energy at this site terminated conduction in both directions. Subsequent atrial pacing of the donor and recipient atria, respectively, demonstrated bidirectional conduction block. CONCLUSION: Symptomatic arrhythmias in patients after heart transplantation can indirectly originate from the donor atrium via bidirectional recipient-donor atrial conduction. This type of arrhythmia can be successfully treated with radiofrequency ablation.
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8/49. Atypical left atrial flutter after intraoperative radiofrequency ablation of chronic atrial fibrillation: successful ablation using three-dimensional electroanatomic mapping.

    Curative treatment of chronic atrial fibrillation (AF) remains a challenging task for electrophysiologists. Eliminating the initiating triggers by focal radiofrequency ablation in a subset of patients with paroxysmal AF and modifying the maintaining substrate by performing linear lesions within the left atrium in patients with prolonged episodes of AF are among the alternative approaches for management of these patients. Recently, a new intraoperative treatment procedure aimed at eliminating left atrial anatomic "anchor" reentrant circuits by induction of contiguous lesions using radiofrequency energy under direct vision was introduced. However, atypical left atrial flutter may occur during follow-up after intraoperative ablation of AF. These arrhythmias most likely are due to discontinuities in linear lesions; therefore, they can be successfully mapped and ablated in a subsequent percutaneous catheter ablation procedure. We report and discuss the case of a patient who underwent successful intraoperative ablation of chronic AF, but who developed atypical left atrial flutter postoperatively. Three-dimensional nonfluoroscopic electroanatomic mapping revealed a gap in the linear lesion line connecting the left upper and right upper pulmonary vein orifices. Ablation at the exit site of the breakthrough was successful.
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9/49. Relation between the rapid focal activation in the pulmonary vein and the maintenance of paroxysmal atrial fibrillation.

    This case report describes a patient with drug refractory paroxysmal atrial fibrillation (PAF). Rapid focal activations with multiple sharp spikes were continuously identified inside the left superior pulmonary vein (PV) during sustained AF. Among seven episodes of AF, cessation of rapid focal activations coincided with the conversion of AF to flutter (n = 4) or immediate AF termination (n = 3). Guided by sharp spikes in the PV, abrupt termination of AF occurred during radiofrequency energy application. Conclusively, rapid focal activations inside the PV are critical in AF maintenance. Cessation of these rapid focal activations underlies the mechanism by which AF converts to flutter.
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10/49. Differential atrial stunning after electrical cardioversion: an echo tissue Doppler case study.

    Left atrial stunning after cardioversion is a well-known phenomenon. It has been associated with higher risk of postcardioversion thromboemboli and increased risk of recurrence of atrial fibrillation. We present a case of differential atrial stunning after electrical cardioversion for atrial fibrillation. diagnosis was made by pulsed wave Doppler of mitral, tricuspid, and pulmonary vein inflow and mitral and tricuspid annuli. Differential mechanical atrial stunning may be a common phenomenon after cardioversion and may suggest difference in right and left atrial transport function. Its prevalence needs to be determined by a large study. Doppler tissue imaging might be routinely used in patients after cardioversion for atrial fibrillation to detect atrial stunning.
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