BACKGROUND: The electrophysiological anatomy of cavotricuspid isthmus-dependent atrial flutter (CVTI-AFL) has not been fully elucidated. METHODS: We studied 602 autopsied human hearts from individuals aged 0 to 103 years. We measured morphological features of the right atrium, including the crista terminalis (CT), pectinate muscles, sub-Eustachian pouch, Thebesian valve (TV), and the coronary sinus (CS) ostium. RESULTS: In adults, the mean right atrium dimensions were 4.7 cm x 4.5 cm x 4.4 cm. Pectinate muscles extended medial to the CT in 54% of hearts. In 19% of hearts, these ended in another ridge termed the second CT. Pectinate muscles extended into the CVTI in 70% of hearts. A sub-Eustachian pouch was present in 16% of hearts, was always located on the septal CVTI, and was more likely when a prominent TV was also present. A TV, present in 62% of all hearts, covered the inferior quadrant of the CS ostium in 9% of these hearts. CONCLUSION: The posterior boundary of the reentrant circuit of CVTI-AFL comprises the Eustachian ridge and CT, but in some patients may also include a second CT. Sub-Eustachian pouches on the septal CVTI are strongly associated with a prominent TV. The lateral CVTI can have prominent pectinate muscles. This comprehensive characterization of the electrophysiological anatomy of the reentrant circuit of CVTI-AFL may provide guidance and improve success during difficult ablations.
BACKGROUND: The electrophysiological anatomy of cavotricuspid isthmus-dependent atrial flutter (CVTI-AFL) has not been fully elucidated. METHODS: We studied 602 autopsied human hearts from individuals aged 0 to 103 years. We measured morphological features of the right atrium, including the crista terminalis (CT), pectinate muscles, sub-Eustachian pouch, Thebesian valve (TV), and the coronary sinus (CS) ostium. RESULTS: In adults, the mean right atrium dimensions were 4.7 cm x 4.5 cm x 4.4 cm. Pectinate muscles extended medial to the CT in 54% of hearts. In 19% of hearts, these ended in another ridge termed the second CT. Pectinate muscles extended into the CVTI in 70% of hearts. A sub-Eustachian pouch was present in 16% of hearts, was always located on the septal CVTI, and was more likely when a prominent TV was also present. A TV, present in 62% of all hearts, covered the inferior quadrant of the CS ostium in 9% of these hearts. CONCLUSION: The posterior boundary of the reentrant circuit of CVTI-AFL comprises the Eustachian ridge and CT, but in some patients may also include a second CT. Sub-Eustachian pouches on the septal CVTI are strongly associated with a prominent TV. The lateral CVTI can have prominent pectinate muscles. This comprehensive characterization of the electrophysiological anatomy of the reentrant circuit of CVTI-AFL may provide guidance and improve success during difficult ablations.
Authors: William C Choe; Sri Sundaram; J Ryan Jordan; Nate Mullins; Charles Boorman; Austin Davies; Alex C Tiftickjian; Sunil Nath Journal: J Interv Card Electrophysiol Date: 2017-07-22 Impact factor: 1.900
Authors: R Rosu; A Abdelaal; M Andronache; G Gusetu; L Muresan; Rp Martins; C Bondor; D Pop; A Malai; M Ilea; C Pop; D Dan; M Puschita; P Nanu; D Zdrenghea Journal: Indian Pacing Electrophysiol J Date: 2011-02-07
Authors: Wiesława Klimek-Piotrowska; Mateusz K Hołda; Mateusz Koziej; Jakub Hołda; Katarzyna Piątek; Kamil Tyrak; Filip Bolechała Journal: PLoS One Date: 2016-09-28 Impact factor: 3.240
Authors: Sylwia Sławek-Szmyt; Krzysztof Szmyt; Czesław Żaba; Marek Grygier; Maciej Lesiak; Aleksander Araszkiewicz Journal: Europace Date: 2021-11-08 Impact factor: 5.214