Activation and Entrainment Mapping Defines the Tricuspid Annulus as the Anterior Barrier in Typical Atrial Flutter

• DOI: 10.1161/01.cir.94.3.398
• Publication Date: 2012-06-12T00:34:42Z
• Authors: Jonathan M. Kalman; Jeffrey E. Olgin; Leslie A. Saxon; Westby G. Fisher; Randall J. Lee; Michael D. Lesh
• Keywords: Flutter; Annulus (botany)

Background The importance of anatomic barriers in the atrial flutter reentry circuit has been well demonstrated canine models. It shown previously that crista terminalis and its continuation as eustachian ridge form a posterior barrier. In this study we tested hypothesis tricuspid annulus forms continuous anterior barrier to circuit. Methods Results Thirteen patients with typical were studied. A 20-pole halo catheter was situated around annulus. mapping used for activation entrainment from seven sequential sites three additional including tip right appendage, at fossa ovalis, distal coronary sinus. Sites considered be within when postpacing interval minus cycle length stimulus time ≤10 ms; outside these intervals >10 ms. All annular circuit; occurred sequentially accounted 100% length. sinus, appendage Conclusions Closely spaced are activated sequentially, all according criteria. This demonstrates constitutes constraining reentrant wave front human counterclockwise flutter.