16. Atrial Flutter.pptx
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Atrial flutter is the second most common type of atrial tachyarrhythmia after atrial fibrillation. There are two main types - typical or type I flutter involves a counter-clockwise circuit around the tricuspid valve with a rate of 240-340 bpm, while atypical or type II flutter uses different circuits with rates over 340 bpm. Ablation targets the isthmus of tissue between the tricuspid valve and inferior vena cava to interrupt the reentrant circuit. Successful ablation is confirmed by demonstrating block in both directions along the ablation line with pacing maneuvers.
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16. Atrial Flutter.pptx
- 1. Proprietary and confidential — do not distribute Atrial Flutter
- 2. Proprietary and confidential — do not distribute 2 Flutter After atrial fibrillation, atrial flutter is the most significant of the atrial tachyarrhythmias. Flutter waves Risk of embolization Co-morbidities common A-V block common Use NavX or Array
- 3. Proprietary and confidential — do not distribute 3 Flutter Type I and Type II Type I (Typical) 240-340 counter-clockwise (Common) & clockwise Isthmus-dependent atrial flutter Typically entrainable.
- 4. Proprietary and confidential — do not distribute 4 Flutter Type II (Atypical) rate greater than 340 Atypical aflutter, not using the isthmus May be crossing the crista terminalis, using slow conduction of incisional scar, but may result from an intraatrial reentrant circuit operating at a faster rate Isthmus conduction may be present Figure of eight pattern
- 5. Proprietary and confidential — do not distribute 5 Mechanism Involves a re-entrant circuit that encircles the tricuspid annulus of the right atrium, with a depolarizing stimulus traveling up the atrial septum, experiencing epicardial break-through superiorly, and traveling back down the atrial free wall and repeating by traveling through a slowly conducting isthmus allowing the rest of the chamber to repolarize and repeat depolarization of the septum.
- 6. Proprietary and confidential — do not distribute 6 Anatomy
- 7. Proprietary and confidential — do not distribute RAO & LAO
- 8. Proprietary and confidential — do not distribute Typical Flutter November 20, 2023 Enter title via "insert>header and footer>footer" | 8
- 9. Proprietary and confidential — do not distribute 9 Catheters and Considerations Diagnostic • 8 French, 63cm, Fast Cath, Guiding introducer from Swartz SR series • SRO, SAFL, RAMP Diagnostic – 4-5-6 French Decapolar, • Fixed Curve: JSN (Josephson), DAO (Damato) –2-5-2, 2-2-2 spacing –Supreme, IBI Inquiry, Response (economy and signal quality) • Steerable Livewire Decapolar, 7FR Livewire Duo-Decapolar (selective spacing), Duo-Deca BDB –Match connector cables
- 10. Proprietary and confidential — do not distribute Catheter Positions
- 12. Proprietary and confidential — do not distribute Fluoroscopic Positions CS DuoDec RV HIS RV HIS CS DuoDec LAO RAO
- 13. Proprietary and confidential — do not distribute Intracardiac Electrogram Recognition – CCW Mapping Sequential activation around the right atrium
- 14. Proprietary and confidential — do not distribute Intracardiac Electrogram Recognition – CW Mapping Sequential activation around the right atrium
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- 18. Proprietary and confidential — do not distribute Bi-directional Block Check CS Pacing Post Ablation, with Isthmus Block
- 19. Proprietary and confidential — do not distribute Bi-directional Block Check LRA Pacing Post Ablation, with Isthmus Block
- 20. Proprietary and confidential — do not distribute 27 Conclusions Study the EKG Confirm diagnosis with pacing for entrainment and block Select the right tools for access and catheter stability Pace to confirm bi-directional block
- 21. Proprietary and confidential — do not distribute Knowledge Check November 20, 2023 28
- 22. Proprietary and confidential — do not distribute Diagnosis?
- 23. Proprietary and confidential — do not distribute Diagnosis? November 20, 2023 Enter title via "insert>header and footer>footer" | 30
- 24. Proprietary and confidential — do not distribute Site of Ablation Cath? November 20, 2023 Enter title via "insert>header and footer>footer" | 31