Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb;10(2):235-248.
doi: 10.1016/j.jacep.2023.10.026. Epub 2023 Dec 6.

Localized Re-Entry Is a Frequent Mechanism of De Novo Atypical Flutter

Alyssa Zaidi  1 , Jared Kirzner  1 , Christopher F Liu  2 , Jim W Cheung  2 , George Thomas  2 , James E Ip  2 , Bruce B Lerman  2 , Steven M Markowitz  3
Affiliations
Free article

Localized Re-Entry Is a Frequent Mechanism of De Novo Atypical Flutter

Alyssa Zaidi et al. JACC Clin Electrophysiol. 2024 Feb.
Free article

Abstract

Background: Limited data exist about the origins and mechanisms of atypical atrial flutter that occurs in the absence of prior ablation or surgery.

Objectives: The aims of this study were to report a large cohort of patients who presented for catheter ablation of de novo atypical flutters, to identify the most common locations and mechanisms of arrhythmia, and to describe outcomes after ablation.

Methods: Demographic, electrophysiological, and outcome data were collected for patients who underwent ablation of de novo atypical flutter.

Results: The mechanisms of 85 atypical flutters were identified in 62 patients and localized to the left atrium (LA) in 58 and right atrium (RA) in 27. In the LA, mechanisms were classified as macro-re-entry in 29 (50%) and localized re-entry in 29 (50%), whereas in the RA, mechanisms were macro-re-entry in 8 (30%) and localized re-entry in 19 (70%) (proportion of localized re-entry in the LA vs. RA, P = 0.08). Nine patients had both localized and macro-re-entrant atypical flutters. In the LA, localized re-entry was commonly found in the anterior LA, followed by the pulmonary veins and septum. In the RA, localized re-entry was found at various sites, including the lateral or posterior RA, septum, and coronary sinus ostium. During 39.4 months (Q1-Q3: 18.2-65.8 months) of follow-up, atrial arrhythmias occurred in 66% of patients after a single ablation and in 50% after >1 ablation. Among patients who underwent repeat ablation, compared with the index arrhythmia, different tachycardia circuits or arrhythmias were documented in 13 of 18 cases (72%).

Conclusions: Atypical atrial flutters in patients without prior surgery or complex ablation are often due to localized re-entry (approximately 50% in the LA and a higher frequency in the RA). Other atrial tachycardias commonly occur during long-term follow-up following ablation, suggesting progressive atrial myopathy in these patients.

Keywords: atrial flutter; atrial tachycardia; catheter ablation; localized re-entry; macro–re-entry.

PubMed Disclaimer

Conflict of interest statement

Funding Support and Author Disclosures This work was supported by the Greenberg Institute for Cardiac Electrophysiology. Dr Markowitz has received consulting fees from Boston Scientific. Dr Liu has received honoraria from Biotronik. Dr Cheung has received consulting fees from Abbott and Boston Scientific; and has received fellowship grant support from Abbott Medical, Biosense Webster, Boston Scientific, and Medtronic. Dr Thomas has received honoraria from Biotronik and Acutus Medical. Dr Ip has received honoraria from Abbott Laboratories; and has received consulting fees from Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Comment in

Publication types

MeSH terms

LinkOut - more resources