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Relationship between anatomic location of the crista terminalis and double potentials recorded during atrial flutter:

Yasuo Okumura1, Ichiro Watanabe, Takeshi Yamada

  • 1Division of Cardiovascular Disease, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.

Journal of Cardiovascular Electrophysiology
|December 22, 2004
PubMed

Insights

The functional line of block in typical atrial flutter (AFL) is not at the crista terminalis (CT) but adjacent to it or in the posteroseptal right atrium (RA). This finding clarifies atrial flutter activation pathways.

Area of Science:

  • Electrophysiology
  • Cardiac Anatomy

Background:

  • Typical atrial flutter (AFL) activation around the tricuspid annulus is known, but right atrial (RA) activation remains unclear.
  • Previous research suggested a block line at the crista terminalis (CT) during AFL.

Purpose of the Study:

  • To investigate the precise location of the conduction block line in typical AFL.
  • To evaluate the relationship between the crista terminalis (CT) and the line of block using intracardiac echocardiography (ICE).

Main Methods:

  • Intracardiac echocardiography (ICE) guided mapping in 21 patients with typical AFL.
  • Utilized a 20-pole roving catheter to identify double potentials (DPs) indicating conduction block.
  • Reconstructed three-dimensional images of the right atrium (RA).

Main Results:

  • A line of conduction block, identified by DPs, was found adjacent to the CT in 12 patients.
  • In 9 patients, the block line was located in the posteroseptal RA.
  • These findings were consistent during both counterclockwise (CCW) and clockwise (CW) AFL.

Conclusions:

  • The functional line of block in typical AFL is not located directly at the CT.
  • The block line is situated at the septal edge of the CT or within the posteroseptal RA.
  • This study refines the understanding of AFL circuit anatomy.
Abstract

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