Demonstration of macroreentry and feasibility of operative therapy in the common type of atrial flutter
Identifieur interne : 004E82 ( Main/Exploration ); précédent : 004E81; suivant : 004E83Demonstration of macroreentry and feasibility of operative therapy in the common type of atrial flutter
Auteurs : George J. Klein [Canada] ; Gerard M. Guiraudon [Canada] ; Arjun D. Sharma [Canada] ; Simon Milstein [Canada]Source :
- The American Journal of Cardiology [ 0002-9149 ] ; 1986.
Abstract
Two patients are described who had recurrent and long-standing atrial flutter of the common type and were referred for electrophysiologic testing and surgical management. In both patients, atrial flutter could be initiated and terminated by programmed stimulation. Atrial endocardial mapping showed earliest activation during flutter at the orifice of the coronary sinus, with activity proceeding to the low atrial septum, high lateral right atrium and low right atrium, respectively. Programmed atrial extrasystoles from the high right atrium at a time when the atrial septal region was refractory advanced atrial flutter in proportion to prematurity of the extrastimulus, while maintaining the low to high activation sequence. Intraoperatively, epicardial atrial mapping revealed a large right atrial reentrant circuit beginning in the posteroseptal region and proceeding superiorly and laterally through the right atrial free wall before returning to its starting point. The narrowest part of the circuit and that showing relatively slow conduction during atrial flutter was observed in the low right atrial tissue between the tricuspid valve ring and the orifices of the inferior vena cava and proximal coronary sinus, respectively. Cryosurgical ablation around the orifice of the coronary sinus and surrounding atrial wail has prevented recurrent atrial flutter over short term follow-up in both patients, although 1 of the patients has required antiarrhythmic therapy for postoperative atrial fibrillation.
Url:
DOI: 10.1016/0002-9149(86)90840-4
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Sharma</name></author><author><name sortKey="Milstein, Simon" sort="Milstein, Simon" uniqKey="Milstein S" first="Simon" last="Milstein">Simon Milstein</name></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:65A85D59ECDCE97AFACF5661F4975C74E09E8941</idno><date when="1986" year="1986">1986</date><idno type="doi">10.1016/0002-9149(86)90840-4</idno><idno type="url">https://api-v5.istex.fr/document/65A85D59ECDCE97AFACF5661F4975C74E09E8941/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">000834</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">000834</idno><idno type="wicri:Area/Istex/Curation">000834</idno><idno type="wicri:Area/Istex/Checkpoint">002475</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Checkpoint">002475</idno><idno type="wicri:doubleKey">0002-9149:1986:Klein G:demonstration:of:macroreentry</idno><idno type="wicri:Area/Main/Merge">005888</idno><idno type="wicri:Area/Main/Curation">004E82</idno><idno type="wicri:Area/Main/Exploration">004E82</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Demonstration of macroreentry and feasibility of operative therapy in the common type of atrial flutter</title><author><name sortKey="Klein, George J" sort="Klein, George J" uniqKey="Klein G" first="George J." last="Klein">George J. Klein</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>From the Departments of Medicine and Surgery, University Hospital, London, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Guiraudon, Gerard M" sort="Guiraudon, Gerard M" uniqKey="Guiraudon G" first="Gerard M." last="Guiraudon">Gerard M. Guiraudon</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>From the Departments of Medicine and Surgery, University Hospital, London, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Sharma, Arjun D" sort="Sharma, Arjun D" uniqKey="Sharma A" first="Arjun D." last="Sharma">Arjun D. Sharma</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>From the Departments of Medicine and Surgery, University Hospital, London, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Milstein, Simon" sort="Milstein, Simon" uniqKey="Milstein S" first="Simon" last="Milstein">Simon Milstein</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>From the Departments of Medicine and Surgery, University Hospital, London, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author></analytic><monogr></monogr><series><title level="j">The American Journal of Cardiology</title><title level="j" type="abbrev">AJC</title><idno type="ISSN">0002-9149</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1986">1986</date><biblScope unit="volume">57</biblScope><biblScope unit="issue">8</biblScope><biblScope unit="page" from="587">587</biblScope><biblScope unit="page" to="591">591</biblScope></imprint><idno type="ISSN">0002-9149</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0002-9149</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Two patients are described who had recurrent and long-standing atrial flutter of the common type and were referred for electrophysiologic testing and surgical management. In both patients, atrial flutter could be initiated and terminated by programmed stimulation. Atrial endocardial mapping showed earliest activation during flutter at the orifice of the coronary sinus, with activity proceeding to the low atrial septum, high lateral right atrium and low right atrium, respectively. Programmed atrial extrasystoles from the high right atrium at a time when the atrial septal region was refractory advanced atrial flutter in proportion to prematurity of the extrastimulus, while maintaining the low to high activation sequence. Intraoperatively, epicardial atrial mapping revealed a large right atrial reentrant circuit beginning in the posteroseptal region and proceeding superiorly and laterally through the right atrial free wall before returning to its starting point. The narrowest part of the circuit and that showing relatively slow conduction during atrial flutter was observed in the low right atrial tissue between the tricuspid valve ring and the orifices of the inferior vena cava and proximal coronary sinus, respectively. Cryosurgical ablation around the orifice of the coronary sinus and surrounding atrial wail has prevented recurrent atrial flutter over short term follow-up in both patients, although 1 of the patients has required antiarrhythmic therapy for postoperative atrial fibrillation.</div></front></TEI><affiliations><list><country><li>Canada</li></country></list><tree><country name="Canada"><noRegion><name sortKey="Klein, George J" sort="Klein, George J" uniqKey="Klein G" first="George J." last="Klein">George J. Klein</name></noRegion><name sortKey="Guiraudon, Gerard M" sort="Guiraudon, Gerard M" uniqKey="Guiraudon G" first="Gerard M." last="Guiraudon">Gerard M. Guiraudon</name><name sortKey="Milstein, Simon" sort="Milstein, Simon" uniqKey="Milstein S" first="Simon" last="Milstein">Simon Milstein</name><name sortKey="Sharma, Arjun D" sort="Sharma, Arjun D" uniqKey="Sharma A" first="Arjun D." last="Sharma">Arjun D. Sharma</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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