[The use of endocavitary fulguration in the treatment of common auricular flutter]

Between April 1990 and July 1991, 10 patients, were fulgurated after right atrial endocardial mapping with the purpose of destroying or modifying the site of origin of atrial flutter. Mean age, 47 years old (23-61), 9 males. All patients suffered "common" atrial flutter episodes with very rapid ventricular response (greater than or equal to 150 beats per minute) refractory to pharmacological therapy. All patients had pathologic potentials with prolonged duration between 90 and 160 ms (m = 109) which preceded other reference electrodes in the high right atrium and His position. Electrical stimulation from that zone provoked the capture entrainment and termination of the flutter; the same configuration of the arrhythmia was obtained with electrical stimulation from the suspected zone. With the catheter in that situation one or two direct current cathodic, unipolar shocks were given with energy of 60-150 Joules (m = 117). In the follow up (16-73 weeks), 8 patients are free of symptoms without drugs, one suffered a new episode after 7 weeks, His fulguration was performed and a permanent pacemaker implanted. The other patient has failed two session and is still on treatment.