Six patients had structural heart disease, but none had an atriotomy. Among the 28 patients, 16 (57%) had documented atrial fibrillation and AFL, whereas 12 had AFL alone. We excluded 328 patients with sole typical isthmus-dependent flutter and 16 with left AFL, leaving 28 (8%) patients (aged 59☑3 years) with atypical right AFL for study. Patients with surgically corrected congenital heart disease were excluded from the study. None of the patients in the present study had been previously reported. Non–isthmus-dependent circuits include upper loop reentry or scar-related circuits.Ī total of 372 consecutive patients with AFL were referred to our institutions for ablation from January 1996 to August 2000. Two patients had atypical right AFL around low voltage areas (“scars”) in the posterolateral right atrium.Ĭonclusions-Atypical right AFL is most commonly associated with an isthmus-dependent mechanism (ie, LLR or subeustachian isthmus breaks). Upper loop reentry was observed in 8 (22%) of 36 episodes and was defined as showing a clockwise orientation with early annular break and wave-front collision over the isthmus. A pattern of posterior breakthrough from the eustachian ridge to the septum was observed in 4 (14%) of 28 patients. Bidirectional isthmus block resulted in elimination of LLR. Among 24 (67%) of 36 episodes of lower loop reentry (LLR), 13 (54%) of 24 episodes had early breakthrough at the lower lateral tricuspid annulus, whereas 11 (46%) of 24 episodes had early breakthrough at the high lateral tricuspid annulus, and 9 (38%) of 24 episodes showed multiple annular breaks. Methods and Results-A total of 28 (8%) of 372 consecutive patients with atrial flutter (AFL) had 36 episodes of sustained atypical right AFL. Customer Service and Ordering Informationīackground-The purpose of our study was to define the incidence and mechanisms of atypical right atrial flutter.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.
Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).
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