Radiofrequency catheter ablation of cavo tricuspid isthmus as treatment of atrial flutter catheter ablation atrial flutter. Medical search. Frequent questions

BACKGROUND AND AIMS: Colchicine is an anti-inflammatory drug that may prevent post-operative atrial fibrillation (POAF). (bvsalud.org)

However, current techniques for ablating complex arrhythmias such as atrial fibrillation and ventricular tachycardia are associated with sub-optimal success rates and prolonged radiation exposure. (rmmj.org.il)
Dr. Olgin's basic research lab is interested in atrial and ventricular remodeling and how these processes occur to develop a substrate for atrial fibrillation and ventricular tachycardia. (ucsf.edu)

For patient education information, see the Heart Health Center , as well as Atrial Flutter , Arrhythmias (Heart Rhythm Disorders) , Stroke , Supraventricular Tachycardia (SVT, PSVT) , and Palpitations . (medscape.com)
Catheter ablation is a first-line treatment for many cardiac arrhythmias and is generally performed under X-ray fluoroscopy guidance. (rmmj.org.il)
Pre-procedure 3-D magnetic resonance imaging (MRI) has improved understanding of the anatomic basis of complex arrhythmias and is being used for planning and guidance of ablation procedures. (rmmj.org.il)
In the future, intra-procedure real-time MRI, together with the ability to image complex 3-D arrhythmogenic anatomy and target additional ablation to regions of incomplete lesion formation, may allow for more successful treatment of even complex arrhythmias without exposure to ionizing radiation. (rmmj.org.il)
Radiofrequency (RF) catheter ablation has advanced over the last 25 years from an experimental procedure to the first-line treatment for a number of cardiac arrhythmias including atrioventricular re - entrant tachycardia, accessory pathway-associated tachycardias, and typical atrial flutter. (rmmj.org.il)
The clinical indications for anatomy-based catheter ablation have since expanded to more complex arrhythmias such as atrial fibrillation and scar-based ventricular tachycardia. (rmmj.org.il)
While the feasibility of X-ray fluoroscopy guidance has been demonstrated for these complex arrhythmias, precise targeting of ablation lesions is limited by fluoroscopy's inherently poor ability to visualize cardiovascular soft tissue anatomy. (rmmj.org.il)

Successful targeting of ablation primarily to the anatomic arrhythmia substrate, as opposed to mapping and targeting ablation based on electrogram characteristics, began with recognition that common atrial flutter passes through a narrow structure known as the cavo-tricuspid isthmus. (rmmj.org.il)
Examples of electrospatial mapping guidance of complex arrhythmia ablation. (rmmj.org.il)

Little more than 3 decades ago, the terminology for this defect (eg, tricuspid atresia, univentricular heart, univentricular atrioventricular connection) was intensely debated. (medscape.com)
In the membranous type (6.6%), the atrioventricular portion of the membranous septum forms the floor of the right atrium at the expected location of the tricuspid valve. (medscape.com)

In this retrospective study, we present our experience with PWI using CF sensing catheters and its efficacy and safety as an adjunctive ablation strategy on top of PVI for management of patients with persistent and longstanding persistent AF. (jafib.com)
We prospectively randomized patients undergoing pulmonary vein isolation to either additional linear ablation, versus the adjunctive ablation targeting fractionated or high-frequency electrograms ablation for the treatment of AF. (jafib.com)

Therefore, although several multicentre randomised trials showed no difference between PVI alone and additional ablation within the left atrium (LA), various methods, including linear ablation and substrate modification, have been introduced to achieve favourable results. (aerjournal.com)
23-25 Linear ablation combined with PVI may result in reentrant ATs because of conduction gaps and non-transmural lesions caused by ablation lesions. (aerjournal.com)
However, due to high recurrence rates, especially in patients with persistent AF, PV antral isolation, complemented by linear ablation, autonomic modulation, and ablation of complex fractionated electrograms, have been attempted to increase the odds of success. (jafib.com)
We performed a prospective randomized trial by assigning 92 patients with persistent AF in 1:1 ratio to pulmonary-vein isolation plus ablation of electrograms showing complex fractionated activity (45 patients), or pulmonary-vein isolation plus additional linear ablation across the left atrial roof and mitral valve isthmus (47 patients). (jafib.com)
At a 12-month follow-up, 9 (23%) patients had AF recurrence in the linear ablation and 8 (21%) patients in the CFAE groups. (jafib.com)
At a mean follow-up duration of 59±36 months, 48.3% of patients in the linear ablation group and 44.6% of patients in the CFAE group were free from AF (p=0.403). (jafib.com)
The overall procedure time and radiation exposure were higher in the PVI+linear ablation group. (jafib.com)
Among patients with persistent atrial fibrillation, we found no difference in maintenance of sinus rhythm in either linear ablation or ablation of complex fractionated electrograms was performed in addition to pulmonary vein isolation in short- and long-term follow-up. (jafib.com)
Furthermore, several randomized studies have produced conflicting results regarding the benefit of adding linear ablation lines, CFAE ablation, both or none. (jafib.com)
Hence we designed a prospective study to establish freedom from AF with combined wide area circumferential ablation and linear ablation, vs. combined wide area circumferential ablation and CFAE ablation in addition to antiarrhythmic therapy. (jafib.com)
Ninety-two patients with symptomatic persistent AF were randomized to PVI+ additional linear ablation group vs. PVI + physiology guided CFAE ablation. (jafib.com)

A particular strength of MRI compared to other imaging modalities is the ability to visualize ablation lesions. (rmmj.org.il)
4 , 5 The basis of these strategies is to target specific anatomic regions and often to create extended ablation "lines" by aligning multiple point lesions or by dragging the catheter along the endocardial surface while applying ablative energy. (rmmj.org.il)
Contact-force (CF) technology was not, however, routinely used in previous prospective studies on percutaneous PWI, even if it provides deeper and more durable lesions when integrated in ablation catheters either in paroxysmal or in persistent AF ablations 12 - 14 . (jafib.com)

Pulmonary vein isolation (PVI) is currently recommended for paroxysmal atrial fibrillation (AF) catheter ablation, but persistent AF remains a clinical challenge 1 - 3 . (jafib.com)

7,8 Hence, catheter ablation has become widely used for treating symptomatic drug-refractory AF, even though the recurrence rates of AF ablation remain high, especially in persistent AF and longstanding persistent AF. (aerjournal.com)

Individuals will build a strong conceptual and practical understanding of cardiac rhythm management, including the diseases and treatments used such as implantable pacemakers and defibrillators. (meddevicecareers.com)
30 seconds at follow up and in addition, in patients provided with insertable cardiac monitors (ICM), as burden of AF or atrial tachycardias (AT) at relevant time points. (jafib.com)
As a pediatric cardiac electrophysiologist, I provide the very best care for my patients through state-of-the-art and evidence-based treatments. (stanfordchildrens.org)
Dr. Olgin's clinical research has focused on atrial fibrillation and sudden cardiac death mechanisms, epidemiology, genetics and interventions. (ucsf.edu)
Cardiac specimen from a patient with the muscular type of tricuspid atresia. (medscape.com)

These include chronic left-sided congestive heart failure , pulmonary embolus, valvular heart disease (especially mitral and tricuspid diseases), and septal defects. (medscape.com)
1 Triggers from the pulmonary vein (PV) have been identified as crucial ectopic sources that initiate AF and pulmonary vein isolation (PVI) is the cornerstone for catheter ablation of AF. (aerjournal.com)
The efficacy of posterior wall isolation (PWI) on top of pulmonary vein isolation (PVI) in patients affected by persistent atrial fibrillation (AF) is still controversial and little is known about the impact of contact-force (CF) technology. (jafib.com)
Pulmonary vein isolation remains the cornerstone of atrial fibrillation (AF) ablation. (jafib.com)

Atrial Tachycardias After Atrial Fibrillation Ablation: How to Manage? (aerjournal.com)

A total of 73 consecutive patients (20.5% female) affected by persistent atrial fibrillation (10.9% long-standing) underwent PWI as an adjunctive therapy to PVI using CF sensing catheters. (jafib.com)
In persistent atrial fibrillation, PWI on top of PVI using CF sensing catheters is safe and effective, providing great reduction of burden of ARs. (jafib.com)
PWI seems to be an alternative option in persistent AF treatment, though technically demanding, uncertain in terms of arrhythmic recurrences (ARs) 8 , 9 and burdened by a great incidence of reconnections at follow-up 10 , 11 . (jafib.com)
However, due to a relatively high recurrence rate, especially in patients with persistent AF, other ablation techniques have been developed, involving a PV antral isolation, often complemented by ablation lines, and ablation of complex fractionated atrial electrograms. (jafib.com)
Tricuspid atresia: association with persistent truncus arteriosus. (medscape.com)

9, 20] It is characterized by a dimple or a localized fibrous thickening in the floor of the right atrium at the expected site of the tricuspid valve. (medscape.com)
The right atrium was opened by cutting through the right atrial appendage (RAA). (medscape.com)

In this review, we summarise the incidence, mechanism, mapping and ablation techniques, and outcomes of AT after AF ablation. (aerjournal.com)
The incidence of AT after AF ablation varies from less than 5% to 40% and is associated with the index ablation strategy and duration of AF. (aerjournal.com)

The septal leaflet of the tricuspid valve mostly develops from the inferior endocardial cushion with a small contribution from the superior cushion. (medscape.com)
An atrial septal defect (ASD) is also shown. (medscape.com)

1 These procedures are typically guided by positioning electrode catheters using X-ray fluoroscopy and using these catheters to observe the propagation of electrical activity through the heart. (rmmj.org.il)
BACKGROUND: Multiple randomized controlled trials (RCTs) have compared the success of antero-lateral vs. antero-posterior electrode position for cardioversion of atrial fibrillation (AF). (bvsalud.org)

Prehospital treatment is usually only indicated in hemodynamically unstable patients. (medscape.com)
Atrial flutter in an unstable patient should be treated immediately with synchronized cardioversion. (medscape.com)
If the affected person is having chest pain, has lost consciousness, or has low blood pressure (unstable atrial flutter), then an urgent electrical shock to the heart to restore a normal heart rhythm is necessary. (wikipedia.org)

High-density mapping can achieve precise identification of the circuits and critical isthmuses of ATs and improve the efficacy of catheter ablation. (aerjournal.com)

9-12 However, atrial tachycardia (AT) occurring after AF ablation is often symptomatic, complex and poorly controlled by anti-arrhythmic agents. (aerjournal.com)

3 ]. PV isolation has been the cornerstone of AF ablation. (jafib.com)

A supraventricular tachycardia with a ventricular heart rate of 150 beats per minute is suggestive (though not necessarily diagnostic) of atrial flutter. (wikipedia.org)
Administration of adenosine in the vein (intravenously) can help medical personnel differentiate between atrial flutter and other forms of supraventricular tachycardia. (wikipedia.org)
AFL is the second most common pathologic supraventricular tachycardia but occurs at a rate less than one-tenth of the most common supraventricular tachycardia (atrial fibrillation). (wikipedia.org)

Rarely, atrial fibrillation or atrial flutter may be due to pericardial disease or effusion or caused by carbon monoxide intoxication. (medscape.com)

Among strategies to achieve atrial compartmentalization and de-bulking, posterior wall isolation (PWI) allows the reduction of LA critical mass and also the suppression of AF triggers and drivers 5 . (jafib.com)
The anterior and posterior tricuspid valve leaflets develop by undermining of a skirt of ventricular muscle tissue. (medscape.com)

The pathologic, clinical, and electrocardiographic features of tricuspid stenosis and atresia are similar. (medscape.com)

This involves the insertion of a catheter through a vein in the groin which is followed up to the heart and is used to identify and interrupt the electrical circuit causing the atrial flutter (by creating a small burn and scar). (wikipedia.org)
2 By directing ablation to interrupt conduction through this region, high cure rates have been achieved with a low risk of complications. (rmmj.org.il)

Since the seminal report by Dr. Michel Haïssaguerre, catheter-based ablation for atrial fibrillation (AF) has evolved and been highly effective for the elimination of atrial fibrillation (AF) compared to antiarrhythmic medications. (jafib.com)

19] Therefore, the fact that isolated congenital tricuspid stenosis belongs to the group of tricuspid atresia defects and that their embryologic developments are similar is no surprise. (medscape.com)

citation needed] Although often regarded as a relatively benign heart rhythm problem, atrial flutter shares the same complications as the related condition atrial fibrillation. (wikipedia.org)

2,3 Per the European and US AF guidelines, catheter ablation of AF is currently recommended as the first-line therapy if anti-arrhythmic agents fail to maintain sinus rhythm. (aerjournal.com)
In the Catheter Ablation Versus Anti-arrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial, the catheter ablation group had superior quality of life compared with the anti-arrhythmic drug group and less AF recurrence after blanking through intention-to-treat analysis. (aerjournal.com)
lt;h4>Benefits and Harms of Standard Versus Reduced-Dose Direct Oral Anticoagulant Therapy for Older Adults With Multiple Morbidities and Atrial Fibrillation. (journalfilter.com)

Because the AV node cannot conduct at the same rate as the atrial activity, some form of conduction block is often seen, typically 2:1 (most common), 3:1, or 4:1. (medscape.com)
It is typically not a stable rhythm, and often degenerates into atrial fibrillation (AF). (wikipedia.org)

Post-procedure MRI is now being applied to assess ablation lesion location and permanence with the goal of identifying factors leading to procedure success and failure. (rmmj.org.il)
The primary endpoint was freedom from any documented recurrence of atrial fibrillation after a single ablation procedure. (jafib.com)

If the valve fusion is incomplete, stenosis of the tricuspid valve develops. (medscape.com)

17, 18] The classic muscular form of tricuspid atresia develops if the embryologic insult occurs early in gestation, and fused valve leaflets occur if the embryologic abnormality occurs slightly later than this in gestation. (medscape.com)

The pathologic anatomy of tricuspid atresia is best understood by reviewing variations in valvar morphology. (medscape.com)

Mapping these ATs is challenging because of atrial remodelling and its complex mechanisms, such as double ATs and multiple-loop ATs. (aerjournal.com)
The purpose of this article is to review the mechanisms, mapping and ablation strategy, and outcome of ATs after AF ablation. (aerjournal.com)

Atrial flutter is the second most common tachyarrhythmia, after atrial fibrillation . (medscape.com)
Atrial flutter (AFL) is a common abnormal heart rhythm that starts in the atrial chambers of the heart. (wikipedia.org)
Tricuspid atresia is the most common cause of cyanosis with left ventricular hypertrophy. (medscape.com)
The most common type of tricuspid atresia is muscular (see the image below). (medscape.com)

9 ]-[ 13 ] Thus a broad spectrum of approaches ranging from strictly anatomical to more physiology-guided ablation has been utilized. (jafib.com)

Long-term use of blood thinners (e.g., warfarin or apixaban) is an important component of treatment to reduce the risk of blood clot formation in the heart and resultant strokes. (wikipedia.org)
We identified DOAC initiators (apixaban, dabigatran, rivaroxaban) aged ≥65 years with nonvalvular atrial fibrillation residing in a nursing home. (journalfilter.com)

Atrial rates are generally between 240 and 360 beats per minute (bpm) without medications. (medscape.com)
citation needed] Prolonged atrial flutter with fast heart rates may lead to decompensation with loss of normal heart function (heart failure). (wikipedia.org)
5 ]-[ 8 ] Methods of targeting left, and right atrial areas of complex, fractionated or high-frequency electrograms have been developed to improve AF success rates. (jafib.com)

Ten patients underwent repeat ablations during the follow-up. (jafib.com)
Among patients provided with ICM, PWI on top of PVI was able to reduce the mean AT/AF burden of more than 50% compared with pre-ablation time, reporting very low levels (≤ 5%) over 2 years. (jafib.com)
I'm committed to providing outstanding treatment for my patients that best fits their lives. (stanfordchildrens.org)
lt;h4>Longitudinal Changes in Health-Related Quality of Life in Patients With Atrial Fibrillation. (journalfilter.com)
Methods and Results We used 5-year follow-up data from the Swiss-Atrial Fibrillation prospective cohort, which enrolled 2415 patients with prevalent AF from 2014 to 2017. (journalfilter.com)

Medications used to restore a normal heart rhythm (antiarrhythmics) such as ibutilide effectively control atrial flutter about 80% of the time when they are started but atrial flutter recurs at a high rate (70-90% of the time) despite continued use. (wikipedia.org)

Twelve-lead ECG of type I atrial flutter. (medscape.com)
Whether a muscular type of tricuspid atresia develops or whether well-formed but fused tricuspid-valve leaflets develop depends on the stage of development when the embryologic aberration takes place. (medscape.com)
Thus, the tricuspid valve stenosis, tricuspid atresia with well formed but fused valve leaflets, and the muscular type of tricuspid atresia represent a spectrum of morphologic abnormalities. (medscape.com)

His work has demonstrated the circuit for human atrial flutter and has demonstrated the importance of atrial fibrosis as a cause for atrial fibrillation. (ucsf.edu)

With catheter ablation becoming effective for non-pharmacological management of AF, many cases of atrial tachycardia (AT) after AF ablation have been reported in the past decade. (aerjournal.com)

At times, treatment of the underlying disorder (eg, thyroid disease, valvular heart disease) is necessary to effect conversion to sinus rhythm. (medscape.com)
Atrial flutter is characterized by a sudden-onset (usually) regular abnormal heart rhythm on an electrocardiogram (ECG) in which the heart rate is fast. (wikipedia.org)
Similar to the abnormal heart rhythm atrial fibrillation, atrial flutter also leads to poor contraction of the atrial chambers of the heart. (wikipedia.org)

4-6 The recent advances in mapping and ablation techniques have provided more efficient non-pharmacological therapies for AF. (aerjournal.com)

Preceding Night Sleep Quality and Atrial Fibrillation Episodes in the I-STOP-AFIB Randomized Trial. (ucsf.edu)
lt;br/>Optimizing health-related quality of life (HRQoL) is an important aim of atrial fibrillation (AF) treatment. (journalfilter.com)

Note negative sawtooth pattern of flutter waves in leads II, III, and aVF. (medscape.com)

26,27 One cohort study conducted in the US demonstrated that ATs after PVI might be single AT or multiple ATs, and nearly 90% were reentrant and associated with gaps in the previous ablation line. (aerjournal.com)

At the time of this update, there is no consensus on the optimal management of atrial flutter in the emergency department, due to a lack of robust evidence, as well as a wide variation in typical management. (medscape.com)

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