Atrial flutter surgery
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Atrial flutter Microchapters |
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Diagnosis |
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Treatment |
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Atrial flutter surgery On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Surgery
Ablation
Because of the reentrant nature of atrial flutter, it is often possible to ablate the circuit that causes atrial flutter. This is done in the electrophysiology lab by causing a ridge of scar tissue that crosses the path of the circuit that causes atrial flutter. Ablation of the isthmus, as discussed above, is a common treatment for typical atrial flutter.
Measurement of Successful Ablation
- Corridor of widely split double potentials 90-110 ms.
- Transisthmus conduction intervals
- Counter clockwise defined as interval between stimulus on lateral wall and proximal coronary sinus electrode.
- Clockwise defined as interval between stimulus in proximal CS and electrodes lateral to line of block.
- Interval measured at 500, 400, and 300 ms. If this value increased by 50% or more this was defined as successs or 150ms.
- Pacing at multiple sites, AD>BD and DA>CA.
- Bipolar electrograms lateral to line and pace from Proximal CS. Transition of polarity from positive to negative.
- 3 pacing site protocol: Pace at two sites lateral (L1R and L2R) to the line on block and on the septal site (S) of the line. Measure the conduction delay from the pacing site to the R wave on the QRS (L1 to R, L2 to R and S to R). If (L1R-L2R) > 0 and (L1R-SR) > 94 then there is a 100% sensitivity and 98% specificity.