Conduction properties of the crista terminalis in patients with typical atrial flutter: Basis for a line of block in the reentrant circuit

Ching Tai Tai, Shih Ann Chen, Yi Jen Chen, Wen Chung Yu, Ming Hsiung Hsieh, Chin Feng Tsai, Chien Cheng Chen, Yu An Ding, Mau Song Chang

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Introduction: Previous mapping studies in patients with typical atrial flutter have demonstrated the crista terminalis to be a posterior barrier of the reentrant circuit forming a line of block. However, the functional role of the crista terminalis in patients with or without a history of atrial flutter is not well known. The aim of this study was to determine whether the conduction properties of the crista terminalis are different between patients with and those without a history of atrial flutter. Methods and Results: The study population consisted of 12 patients with clinically documented atrial flutter (group 1) and 12 patients with paroxysmal supraventricular tachycardia as well as induced atrial flutter (group 2). A 7-French, 20- pole, deflectable Halo catheter was positioned around the tricuspid annulus. A 7-French, 20-pole Crista catheter was placed along the crista terminalis identified by the recording of double potentials with opposite activation sequences during typical atrial flutter. After sinus rhythm was restored, pacing from the low posterior right atrium near the crista terminalis was performed at multiple cycle length to 2:1 atrial capture. No double potentials were recorded along the crista terminalis during sinus rhythm in both groups. In group 1, the longest pacing cycle length that resulted in a line of block with double potentials along the crista terminalis was 638 ± 119 msec. After infusion of propranolol, it was prolonged to 832 ± 93 msec without change of the interdeflection intervals of double potentials. In group 2, the longest pacing cycle length that resulted in a line of block with double potentials along the crista terminalis was 214 ± 23 msec. After infusion of procainamide, it was prolonged to 306 ± 36 msec with increase of interdeflection interval of double potentials. Conclusion: The crista terminalis forms a line of transverse conduction block during typical atrial flutter. Poor transverse conduction property in the crista terminalis may be the requisite substrate for clinical occurrence of typical atrial flutter.

Original languageEnglish
Pages (from-to)811-819
Number of pages9
JournalJournal of Cardiovascular Electrophysiology
Volume9
Issue number8
Publication statusPublished - 1998
Externally publishedYes

Fingerprint

Atrial Flutter
Catheters
Procainamide
Paroxysmal Tachycardia
Supraventricular Tachycardia
Heart Atria
Propranolol

Keywords

  • Atrial flutter
  • Crista terminalis
  • Double potentials

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

Conduction properties of the crista terminalis in patients with typical atrial flutter : Basis for a line of block in the reentrant circuit. / Tai, Ching Tai; Chen, Shih Ann; Chen, Yi Jen; Yu, Wen Chung; Hsieh, Ming Hsiung; Tsai, Chin Feng; Chen, Chien Cheng; Ding, Yu An; Chang, Mau Song.

In: Journal of Cardiovascular Electrophysiology, Vol. 9, No. 8, 1998, p. 811-819.

Research output: Contribution to journalArticle

Tai, Ching Tai ; Chen, Shih Ann ; Chen, Yi Jen ; Yu, Wen Chung ; Hsieh, Ming Hsiung ; Tsai, Chin Feng ; Chen, Chien Cheng ; Ding, Yu An ; Chang, Mau Song. / Conduction properties of the crista terminalis in patients with typical atrial flutter : Basis for a line of block in the reentrant circuit. In: Journal of Cardiovascular Electrophysiology. 1998 ; Vol. 9, No. 8. pp. 811-819.
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T1 - Conduction properties of the crista terminalis in patients with typical atrial flutter

T2 - Basis for a line of block in the reentrant circuit

AU - Tai, Ching Tai

AU - Chen, Shih Ann

AU - Chen, Yi Jen

AU - Yu, Wen Chung

AU - Hsieh, Ming Hsiung

AU - Tsai, Chin Feng

AU - Chen, Chien Cheng

AU - Ding, Yu An

AU - Chang, Mau Song

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N2 - Introduction: Previous mapping studies in patients with typical atrial flutter have demonstrated the crista terminalis to be a posterior barrier of the reentrant circuit forming a line of block. However, the functional role of the crista terminalis in patients with or without a history of atrial flutter is not well known. The aim of this study was to determine whether the conduction properties of the crista terminalis are different between patients with and those without a history of atrial flutter. Methods and Results: The study population consisted of 12 patients with clinically documented atrial flutter (group 1) and 12 patients with paroxysmal supraventricular tachycardia as well as induced atrial flutter (group 2). A 7-French, 20- pole, deflectable Halo catheter was positioned around the tricuspid annulus. A 7-French, 20-pole Crista catheter was placed along the crista terminalis identified by the recording of double potentials with opposite activation sequences during typical atrial flutter. After sinus rhythm was restored, pacing from the low posterior right atrium near the crista terminalis was performed at multiple cycle length to 2:1 atrial capture. No double potentials were recorded along the crista terminalis during sinus rhythm in both groups. In group 1, the longest pacing cycle length that resulted in a line of block with double potentials along the crista terminalis was 638 ± 119 msec. After infusion of propranolol, it was prolonged to 832 ± 93 msec without change of the interdeflection intervals of double potentials. In group 2, the longest pacing cycle length that resulted in a line of block with double potentials along the crista terminalis was 214 ± 23 msec. After infusion of procainamide, it was prolonged to 306 ± 36 msec with increase of interdeflection interval of double potentials. Conclusion: The crista terminalis forms a line of transverse conduction block during typical atrial flutter. Poor transverse conduction property in the crista terminalis may be the requisite substrate for clinical occurrence of typical atrial flutter.

AB - Introduction: Previous mapping studies in patients with typical atrial flutter have demonstrated the crista terminalis to be a posterior barrier of the reentrant circuit forming a line of block. However, the functional role of the crista terminalis in patients with or without a history of atrial flutter is not well known. The aim of this study was to determine whether the conduction properties of the crista terminalis are different between patients with and those without a history of atrial flutter. Methods and Results: The study population consisted of 12 patients with clinically documented atrial flutter (group 1) and 12 patients with paroxysmal supraventricular tachycardia as well as induced atrial flutter (group 2). A 7-French, 20- pole, deflectable Halo catheter was positioned around the tricuspid annulus. A 7-French, 20-pole Crista catheter was placed along the crista terminalis identified by the recording of double potentials with opposite activation sequences during typical atrial flutter. After sinus rhythm was restored, pacing from the low posterior right atrium near the crista terminalis was performed at multiple cycle length to 2:1 atrial capture. No double potentials were recorded along the crista terminalis during sinus rhythm in both groups. In group 1, the longest pacing cycle length that resulted in a line of block with double potentials along the crista terminalis was 638 ± 119 msec. After infusion of propranolol, it was prolonged to 832 ± 93 msec without change of the interdeflection intervals of double potentials. In group 2, the longest pacing cycle length that resulted in a line of block with double potentials along the crista terminalis was 214 ± 23 msec. After infusion of procainamide, it was prolonged to 306 ± 36 msec with increase of interdeflection interval of double potentials. Conclusion: The crista terminalis forms a line of transverse conduction block during typical atrial flutter. Poor transverse conduction property in the crista terminalis may be the requisite substrate for clinical occurrence of typical atrial flutter.

KW - Atrial flutter

KW - Crista terminalis

KW - Double potentials

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