Manuscript received May 1, 2011, final version accepted June 1, 2011.Īddress correspondence to: Hakan Paydak, MD Director, Clinical Cardiac Electrophysiology, Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 532, Little Rock, AR 72205-7199. The authors report no conflicts of interest for the published content. atrial flutter, intra-isthmus re-entry, surface electrocardiogram. Radiofrequency energy applications led to elimination of atrial flutter without recurrence during follow-up. Entrainment mapping suggested a micro re-entrant circuit localized to the CTI–CS ostium region, consistent with intra-isthmus re-entry atrial flutter. ![]() Earliest atrial activation and double potentials occurred around the ostium of the coronary sinus (CS). We herein present a clinical case in which the electrophysiology study demonstrated a simultaneous CCW and clockwise (CW) pattern occurring during spontaneous atrial flutter despite the typical CCW CTI-dependent atrial flutter appearance on the surface ECG. However, the surface ECG presentation does not reliably predict the mechanism of atrial flutter, especially in the setting of intra-isthmus entry. Surface electrocardiogram (ECG) is routinely used for assessment of atrial flutter including typical counterclockwise (CCW) cavotricuspid isthmus (CTI)-dependent atrial flutter, manifesting as an inverted sawtooth F-wave pattern in the inferior ECG leads II, III, and aVF, and an upright F wave in the precordial lead V 1. ![]() KARAM, MD and HAKAN PAYDAK, MD, FACCĭivision of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, ARĪBSTRACT. Intra-Isthmus Re-entry: Beyond the Predictability by Atrial Flutter Wave Morphology on Surface Electrocardiogram
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