![]() ![]() Atypical flutter waves had broad positive terminal portion or entirely positive wave in the inferior leads and in V(1), with a distal-to-proximal or fused activation pattern in the CS, and an average activation time of 21.3 +/- 11.4 ms. Typical and atypical flutter waves were found in 47.8% and 13.0% of the episodes, respectively. ![]() In 46 episodes of counterclockwise AFL (CCW-AFL), there were four types of flutter waves on ECG. The activation patterns of coronary sinus (CS) and their relationship with flutter wave morphology on the ECG were analyzed. Sixty-three episodes of isthmus-dependent atrial flutter (AFL) in 55 patients were studied to characterize variations in flutter wave morphology and to investigate the mechanisms of the atypical flutter waves on surface ECG. Radiofrequency CA is a feasible and effective treatment in such cases. Spontaneous LAAW scarring is an unusual cause of MRAT, showing activation patterns with a figure-eight configuration. Successful ablation of the isthmus caused interruption of the tachycardia and rendered it noninducible in all patients. The conduction velocity was significantly slower in the isthmus between the scar in the LAAW and the mitral annulus than in the lateral mitral annulus (0.17 ± 0.05 m/s vs 0.94 ± 0.35 m/s P = 0.003). The mean tachycardia cycle length was 303 ± 49 milliseconds. The activation map showed a figure-eight circuit with loops around the mitral annulus (4 counterclockwise and 2 clockwise) and a low-voltage area with LAAW scarring. Spontaneous scars (areas with bipolar voltage ≤ 0.05 mV) were observed in all patients. No patient had a history of cardiac surgery or CA in the left atrium. Here, we describe left atrial MRAT in patients without prior cardiac surgery or catheter ablation (CA) and discuss the clinical and electrophysiological characteristics of tachycardia and outcome of CA.Īn electrophysiological study and CA were performed in 6 patients (3 men age 76 ± 6 years) with MRAT originating from the left atrial anterior wall (LAAW). ![]() Left atrial tachycardia and flutter are common in patients who undergo atrial fibrillation ablation however, few reports describe left atrial MRAT involving the regions of spontaneous scarring. Macroreentrant atrial tachycardia (MRAT) has been described most frequently in patients with prior cardiac surgery. ![]()
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