Noncontact three-dimensional mapping and ablation of upper loop re-entry originating in the right atrium

Ching Tai Tai, Jin Long Huang, Yung Kuo Lin, Ming Hsiung Hsieh, Pi Chang Lee, Yu An Ding, Mau Song Chang, Shih Ann Chen

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: This study was aimed at delineating the reentrant circuit of right atrial (RA) upper loop re-entry using noncontact three-dimensional mapping. BACKGROUND: Various forms of atypical atrial flutter including lower loop re-entry and left atrial flutter have been demonstrated. However, little is known about upper loop re-entry in the RA. METHODS: The study population consisted of eight patients (65 ± 12 years, seven men) with atypical atrial flutter. Right atrial activation during atrial flutter was visualized using a noncontact mapping system (EnSite-3000 with Clarity Software, St. Paul, Minnesota) for a three-dimensional reconstruction of the endocardial depolarization. The narrowest parr of the re-entrant circuit was targeted using radiofrequency catheter ablation. RESULTS: Noncontact mapping showed macro-re-entry confined to the RA free wall with RA activation time accounting for 100% of the cycle length (214 ± 21 ms) in all eight patients. Two patients had counterclockwise activation, and six patients had clockwise activation around the central obstacle, which was composed of the crista terminalis, the area of functional block, and superior vena cava. The lower turn-around points were located at the conduction gap in the crista terminalis. Radiofrequency linear ablation of the conduction gap in the crista terminalis was performed and eliminated atrial flutter in six patients without recurrence during a follow-up of 3.2 ± 1.1 months. CONCLUSIONS: Atypical atrial flutter could arise from upper loop re-entry in the RA with conduction through the gap in the crista terminalis. Radiofrequency linear ablation of the conduction gap was effective in eliminating this atrial arrhythmia.

Original languageEnglish
Pages (from-to)746-753
Number of pages8
JournalJournal of the American College of Cardiology
Volume40
Issue number4
DOIs
Publication statusPublished - Aug 21 2002
Externally publishedYes

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Atrial Flutter
Heart Atria
Superior Vena Cava
Catheter Ablation
Cardiac Arrhythmias
Software
Recurrence
Population

ASJC Scopus subject areas

  • Nursing(all)

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Noncontact three-dimensional mapping and ablation of upper loop re-entry originating in the right atrium. / Tai, Ching Tai; Huang, Jin Long; Lin, Yung Kuo; Hsieh, Ming Hsiung; Lee, Pi Chang; Ding, Yu An; Chang, Mau Song; Chen, Shih Ann.

In: Journal of the American College of Cardiology, Vol. 40, No. 4, 21.08.2002, p. 746-753.

Research output: Contribution to journalArticle

Tai, Ching Tai ; Huang, Jin Long ; Lin, Yung Kuo ; Hsieh, Ming Hsiung ; Lee, Pi Chang ; Ding, Yu An ; Chang, Mau Song ; Chen, Shih Ann. / Noncontact three-dimensional mapping and ablation of upper loop re-entry originating in the right atrium. In: Journal of the American College of Cardiology. 2002 ; Vol. 40, No. 4. pp. 746-753.
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abstract = "OBJECTIVES: This study was aimed at delineating the reentrant circuit of right atrial (RA) upper loop re-entry using noncontact three-dimensional mapping. BACKGROUND: Various forms of atypical atrial flutter including lower loop re-entry and left atrial flutter have been demonstrated. However, little is known about upper loop re-entry in the RA. METHODS: The study population consisted of eight patients (65 ± 12 years, seven men) with atypical atrial flutter. Right atrial activation during atrial flutter was visualized using a noncontact mapping system (EnSite-3000 with Clarity Software, St. Paul, Minnesota) for a three-dimensional reconstruction of the endocardial depolarization. The narrowest parr of the re-entrant circuit was targeted using radiofrequency catheter ablation. RESULTS: Noncontact mapping showed macro-re-entry confined to the RA free wall with RA activation time accounting for 100{\%} of the cycle length (214 ± 21 ms) in all eight patients. Two patients had counterclockwise activation, and six patients had clockwise activation around the central obstacle, which was composed of the crista terminalis, the area of functional block, and superior vena cava. The lower turn-around points were located at the conduction gap in the crista terminalis. Radiofrequency linear ablation of the conduction gap in the crista terminalis was performed and eliminated atrial flutter in six patients without recurrence during a follow-up of 3.2 ± 1.1 months. CONCLUSIONS: Atypical atrial flutter could arise from upper loop re-entry in the RA with conduction through the gap in the crista terminalis. Radiofrequency linear ablation of the conduction gap was effective in eliminating this atrial arrhythmia.",
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AU - Huang, Jin Long

AU - Lin, Yung Kuo

AU - Hsieh, Ming Hsiung

AU - Lee, Pi Chang

AU - Ding, Yu An

AU - Chang, Mau Song

AU - Chen, Shih Ann

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N2 - OBJECTIVES: This study was aimed at delineating the reentrant circuit of right atrial (RA) upper loop re-entry using noncontact three-dimensional mapping. BACKGROUND: Various forms of atypical atrial flutter including lower loop re-entry and left atrial flutter have been demonstrated. However, little is known about upper loop re-entry in the RA. METHODS: The study population consisted of eight patients (65 ± 12 years, seven men) with atypical atrial flutter. Right atrial activation during atrial flutter was visualized using a noncontact mapping system (EnSite-3000 with Clarity Software, St. Paul, Minnesota) for a three-dimensional reconstruction of the endocardial depolarization. The narrowest parr of the re-entrant circuit was targeted using radiofrequency catheter ablation. RESULTS: Noncontact mapping showed macro-re-entry confined to the RA free wall with RA activation time accounting for 100% of the cycle length (214 ± 21 ms) in all eight patients. Two patients had counterclockwise activation, and six patients had clockwise activation around the central obstacle, which was composed of the crista terminalis, the area of functional block, and superior vena cava. The lower turn-around points were located at the conduction gap in the crista terminalis. Radiofrequency linear ablation of the conduction gap in the crista terminalis was performed and eliminated atrial flutter in six patients without recurrence during a follow-up of 3.2 ± 1.1 months. CONCLUSIONS: Atypical atrial flutter could arise from upper loop re-entry in the RA with conduction through the gap in the crista terminalis. Radiofrequency linear ablation of the conduction gap was effective in eliminating this atrial arrhythmia.

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