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Updated: Jun 28, 2026
07:41
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Cavotricuspid isthmus conduction split by pouch-like recesses during typical atrial flutter
Yasushi Oginosawa1, Akihiko Nogami, Kenji Kurosaki
1Division of Cardiology, Yokohama Rosai Hospital, Kohoku-ku, Yokohama, Japan.
Summary
A deep pouch in the heart
Area of Science:
- Electrophysiology
- Cardiac Anatomy
- Atrial Flutter Ablation
Background:
- Typical cavotricuspid-isthmus-dependent atrial flutter (AFL) is a common arrhythmia.
- Understanding the anatomical substrates influencing AFL is crucial for effective ablation.
Observation:
- A deep pouch-like recess was identified in the mid-isthmus region of a patient with typical AFL.
- This anatomical feature was visualized using right atrial angiography and multidetector computed tomography.
Findings:
- Linear ablation from the pouch to the inferior vena cava created widely split double potentials.
- The AFL cycle length remained unchanged, suggesting the pouch divided the flutter wavefront.
Implications:
- The pouch appears to play a significant electrophysiological role in typical AFL by creating parallel conduction pathways.
- Targeting the unaffected side of the pouch after creating split potentials on one side may improve ablation outcomes.
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