Cavotricuspid Isthmus-Dependent Atrial Flutter. Beyond Simple Linear Ablation

The demonstration of a peritricuspid circular movement with a zone of slow conduction in the cavotricuspid isthmus, together with the high efficacy of linear ablation and widely accepted acute endpoints, has established typical flutter as a disease with a well-defined physiopathology and treatment....

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Autores: Abdala-Lizarraga, Julian, Quesada Ocete, Francisco Javier, Quesada Ocete, Blanca, Jiménez Bello, Javier
Tipo de recurso: artículo
Fecha de publicación:2024
País:España
Institución:Universidad Católica de Valencia San Vicente Mártir
Repositorio:RIUCV. Repositorio de la Universidad Católica de Valencia San Vicente Mártir
Idioma:inglés
OAI Identifier:oai:riucv.ucv.es:20.500.12466/4369
Acceso en línea:http://hdl.handle.net/20.500.12466/4369
Access Level:acceso abierto
Palabra clave:Atrial flutter
Cavotricuspid isthmus
Catheter ablation
Electrophysiology
3205.01 Cardiología
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spelling Cavotricuspid Isthmus-Dependent Atrial Flutter. Beyond Simple Linear AblationAbdala-Lizarraga, JulianQuesada Ocete, Francisco JavierQuesada Ocete, BlancaJiménez Bello, JavierAtrial flutterCavotricuspid isthmusCatheter ablationElectrophysiology3205.01 CardiologíaThe demonstration of a peritricuspid circular movement with a zone of slow conduction in the cavotricuspid isthmus, together with the high efficacy of linear ablation and widely accepted acute endpoints, has established typical flutter as a disease with a well-defined physiopathology and treatment. However, certain aspects regarding its deeper physiopathology, ablation targets, and methods for verifying the results remain to be clarified. While current research efforts have primarily been focused on the advancement of effective ablation techniques, it is crucial to continue exploring the intricate electrophysiological, ultrastructural, and pharmacological pathways that underlie the development of atrial flutter. This ongoing investigation is essential for the development of targeted preventive strategies that can act upon the specific mechanisms responsible for the initiation and maintenance of this arrhythmia. In this work, we will discuss less ascertained aspects alongside the most widely recognized general data, as well as the most recent or less commonly used contributions regarding the electrophysiological evaluation and ablation of typical atrial flutter. Regarding electrophysiological characteristics, one of the most intriguing findings is the presence of low voltage zones in some of these patients together with the presence of a functional, unidirectional line of block between the two vena cava. It is theorized that episodes of paroxysmal atrial fibrillation can trigger this line of block, which may then allow the onset of stable atrial flutter. Without this, the patient will either remain in atrial fibrillation or return to sinus rhythm. Another of the most important pending tasks is identifying patients at risk of developing post-ablation atrial fibrillation. Discriminating between individuals who will experience a complete arrhythmia cure and those who will develop atrial fibrillation after flutter ablation, remains essential given the important prognostic and therapeutic implications. From the initial X-ray guided linear cavotricuspid ablation, several alternatives have arisen in the last decade: electrophysiological criteria-directed point applications based on entrainment mapping, applications directed by maximum voltage criteria or by wavefront speed and maximum voltage criteria (omnipolar mapping). Electro-anatomical navigation systems offer substantial support in all three strategies. Finally, the electrophysiological techniques to confirm the success of the procedure are reviewed.20242024-06-1320242024-01-0920242024-01-09journal articlehttp://purl.org/coar/resource_type/c_6501info:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/20.500.12466/4369reponame:RIUCV. Repositorio de la Universidad Católica de Valencia San Vicente Mártirinstname:Universidad Católica de Valencia San Vicente MártirInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Atribución 4.0 Internacionalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:riucv.ucv.es:20.500.12466/43692026-06-19T08:32:07Z
dc.title.none.fl_str_mv Cavotricuspid Isthmus-Dependent Atrial Flutter. Beyond Simple Linear Ablation
title Cavotricuspid Isthmus-Dependent Atrial Flutter. Beyond Simple Linear Ablation
spellingShingle Cavotricuspid Isthmus-Dependent Atrial Flutter. Beyond Simple Linear Ablation
Abdala-Lizarraga, Julian
Atrial flutter
Cavotricuspid isthmus
Catheter ablation
Electrophysiology
3205.01 Cardiología
title_short Cavotricuspid Isthmus-Dependent Atrial Flutter. Beyond Simple Linear Ablation
title_full Cavotricuspid Isthmus-Dependent Atrial Flutter. Beyond Simple Linear Ablation
title_fullStr Cavotricuspid Isthmus-Dependent Atrial Flutter. Beyond Simple Linear Ablation
title_full_unstemmed Cavotricuspid Isthmus-Dependent Atrial Flutter. Beyond Simple Linear Ablation
title_sort Cavotricuspid Isthmus-Dependent Atrial Flutter. Beyond Simple Linear Ablation
dc.creator.none.fl_str_mv Abdala-Lizarraga, Julian
Quesada Ocete, Francisco Javier
Quesada Ocete, Blanca
Jiménez Bello, Javier
author Abdala-Lizarraga, Julian
author_facet Abdala-Lizarraga, Julian
Quesada Ocete, Francisco Javier
Quesada Ocete, Blanca
Jiménez Bello, Javier
author_role author
author2 Quesada Ocete, Francisco Javier
Quesada Ocete, Blanca
Jiménez Bello, Javier
author2_role author
author
author
dc.contributor.none.fl_str_mv
dc.subject.none.fl_str_mv Atrial flutter
Cavotricuspid isthmus
Catheter ablation
Electrophysiology
3205.01 Cardiología
topic Atrial flutter
Cavotricuspid isthmus
Catheter ablation
Electrophysiology
3205.01 Cardiología
description The demonstration of a peritricuspid circular movement with a zone of slow conduction in the cavotricuspid isthmus, together with the high efficacy of linear ablation and widely accepted acute endpoints, has established typical flutter as a disease with a well-defined physiopathology and treatment. However, certain aspects regarding its deeper physiopathology, ablation targets, and methods for verifying the results remain to be clarified. While current research efforts have primarily been focused on the advancement of effective ablation techniques, it is crucial to continue exploring the intricate electrophysiological, ultrastructural, and pharmacological pathways that underlie the development of atrial flutter. This ongoing investigation is essential for the development of targeted preventive strategies that can act upon the specific mechanisms responsible for the initiation and maintenance of this arrhythmia. In this work, we will discuss less ascertained aspects alongside the most widely recognized general data, as well as the most recent or less commonly used contributions regarding the electrophysiological evaluation and ablation of typical atrial flutter. Regarding electrophysiological characteristics, one of the most intriguing findings is the presence of low voltage zones in some of these patients together with the presence of a functional, unidirectional line of block between the two vena cava. It is theorized that episodes of paroxysmal atrial fibrillation can trigger this line of block, which may then allow the onset of stable atrial flutter. Without this, the patient will either remain in atrial fibrillation or return to sinus rhythm. Another of the most important pending tasks is identifying patients at risk of developing post-ablation atrial fibrillation. Discriminating between individuals who will experience a complete arrhythmia cure and those who will develop atrial fibrillation after flutter ablation, remains essential given the important prognostic and therapeutic implications. From the initial X-ray guided linear cavotricuspid ablation, several alternatives have arisen in the last decade: electrophysiological criteria-directed point applications based on entrainment mapping, applications directed by maximum voltage criteria or by wavefront speed and maximum voltage criteria (omnipolar mapping). Electro-anatomical navigation systems offer substantial support in all three strategies. Finally, the electrophysiological techniques to confirm the success of the procedure are reviewed.
publishDate 2024
dc.date.none.fl_str_mv 2024
2024-06-13
2024
2024-01-09
2024
2024-01-09
dc.type.none.fl_str_mv journal article
http://purl.org/coar/resource_type/c_6501
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv http://hdl.handle.net/20.500.12466/4369
url http://hdl.handle.net/20.500.12466/4369
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Atribución 4.0 Internacional
http://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Atribución 4.0 Internacional
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:RIUCV. Repositorio de la Universidad Católica de Valencia San Vicente Mártir
instname:Universidad Católica de Valencia San Vicente Mártir
instname_str Universidad Católica de Valencia San Vicente Mártir
reponame_str RIUCV. Repositorio de la Universidad Católica de Valencia San Vicente Mártir
collection RIUCV. Repositorio de la Universidad Católica de Valencia San Vicente Mártir
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,812429

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