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Typical atrial flutter with atypical flutter wave morphology due to abnormal interatrial conduction.
Tadanobu Irie1, Yoshiaki Kaneko, Tadashi Nakajima
1Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, Japan.
Cardiology Journal
|July 20, 2011
Summary
We found a typical counterclockwise atrial flutter (AFL) with a conduction block between the atria. This electrical detour caused unusual flutter wave patterns, highlighting alternative atrial connections.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Anatomy
Background:
- Atrial flutter (AFL) is a common supraventricular tachyarrhythmia.
- Understanding interatrial conduction pathways is crucial for managing complex arrhythmias.
- The coronary sinus (CS) is a key anatomical structure in cardiac electrophysiology.
Observation:
- A case of typical counterclockwise AFL demonstrated a conduction block along the coronary sinus (CS) musculature.
- Discontinuous CS activation sequences during pacing near the ostium confirmed the block.
- Differential right atrial pacing further supported the right-to-left atrial conduction block.
Findings:
- The AFL exhibited atypical flutter wave morphology.
- This morphology resulted from the activation wavefront detouring between the atria.
- Alternate interatrial electrical connections, including Bachmann's bundle and the interatrial septum, were implicated.
Implications:
- This case highlights the importance of considering alternative interatrial pathways in AFL.
- Understanding these pathways can refine ablation strategies for complex atrial arrhythmias.
- Detailed electrophysiological mapping is essential for diagnosing conduction abnormalities.
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