Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
J Cardiovasc Electrophysiol. 2011 Apr;22(4):422-30. doi: 10.1111/j.1540-8167.2010.01917.x. Epub 2010 Oct 11.
Reentry utilizing cavotricuspid isthmus (CTI) is accepted as the mechanism underlying typical atrial flutter (AFLT). However, it is unclear how the right atrial (RA) posterior wall (PW) participates in AFLT circuit. We sought to investigate this by using noncontact electroanatomic mapping.
Fifteen patients (pts) undergoing ablation for typical AFLT participated. Multipolar catheters were deployed in RA and coronary sinus. RA shell was created during AFLT. Entrainment was performed to confirm CTI dependence and assess participation of various RA regions (septum-Sep, PW, lateral wall-LW). Data were analyzed for (1) RA activation patterns and (2) conduction time (CT) through various RA regions.
Mean pt age was 70 ± 13 years (all males; CCW = 10; CW = 5). Mean AFLT cycle length was 255 ± 15 ms. Single activation wave front traversing sequentially CTI, Sep, and LW was seen in all pts and in 12 (80%; 9 CCW, 3 CW) this also traversed PW. Entrainment confirmed PW participation in 7 of these. Mean CT (in ms) through various RA regions was as follows: CTI = 69 ± 27, Sep = 50 ± 39, PW = 65 ± 35, and LW = 76 ± 35; P = NS.
These observations offer new insights regarding the participation of PW in the reentrant circuit of typical AFLT in some patients.
利用三尖瓣峡部（CTI）再进入是典型的心房扑动（AFLT）的潜在机制。然而，右心房（RA）后壁（PW）如何参与AFLT 环尚不清楚。我们试图通过使用非接触式电解剖图来研究这一点。
15 名接受典型 AFLT 消融的患者参与了研究。多极导管被部署在 RA 和冠状窦中。在 AFLT 期间创建 RA 壳。进行拖带以确认 CTI 依赖性并评估各种 RA 区域（间隔-Sep、PW、外侧壁-LW）的参与。数据进行了分析，以（1）RA 激活模式和（2）通过各种 RA 区域的传导时间（CT）。
平均患者年龄为 70 ± 13 岁（均为男性；逆时针= 10；顺时针= 5）。平均 AFLT 周期长度为 255 ± 15 ms。所有患者均可见单个激活波阵面依次穿过 CTI、Sep 和 LW，其中 12 例（80%；9 例逆时针，3 例顺时针）也穿过 PW。在这 7 例中，拖带证实 PW 参与。通过各种 RA 区域的平均 CT（ms）如下：CTI = 69 ± 27，Sep = 50 ± 39，PW = 65 ± 35，LW = 76 ± 35；P = NS。
这些观察结果为某些患者中 PW 在典型 AFLT 的折返环中的参与提供了新的见解。
