An extremely high generator impedance in the blood pool can be observed in a patient with severe polycythemia. However, ablation can be performed safely as long as the generator impedance during contact with the myocardial tissue is within acceptable limits.

Epicardial connections provided the anatomical substrate for the biatrial reentry circuit. The connections between the right atrium and right pulmonary vein were called \"intercaval bundle,\" and there are few reports of atrial flutter related to this bundle. We present a case of a biatrial tachycardia, involving the intercaval bundle.

BACKGROUND: Atrial flutter (AFL) and atrial fibrillation (AF) are the most commonly detected supraventricular arrhythmias and share similar pathophysiological mechanisms. After the successful ablation of AFL, AF frequently occurs in the long-term follow-up. As emphasized in some studies, certain mechanisms seem to predispose to the development of AF in AFL patients, and approximately 20% of these patients have accompanying AFL.
OBJECTIVE: We aimed to analyze independent risk factors that predict the development of AF in patients who underwent typical AFL ablation.
METHODS: This was a multicenter, cross-sectional, and retrospective study. A total of 442 patients who underwent typical AFL ablation at three different centers between January 1, 2018 and January 1, 2022 were included retrospectively. After the ablation procedure the patients were divided into those who developed AF and those who did not. The patients were followed up for an average of 12 (4-20) months. In the post-procedural period, atrial arrhythmias were investigated with 24‑h Holter and ECG at 1 month, 6 months, and 12 months and then at 6‑month intervals thereafter.
RESULTS: Overall, AF developed in 206 (46.6%) patients in the long-term follow-up. Age, hypertension (HT), obstructive sleep apnea syndrome (OSAS), previous cerebrovascular accident (CVA), left atrium anteroposterior diameter, severe mitral regurgitation, hemoglobin, blood glucose, and HbA1c values were found to be significant in univariable analysis. According to multivariable analysis, HT (p = 0.014; HR: 1.483 [1.084-2.030]), OSAS (p = 0.008; HR: 1.520 [1.117-2.068]) and previous CVA (p = 0.038; HR: 1.749 [1.031-2.968]) were independently associated with the development of AF in AFL patients who underwent ablation procedure.
CONCLUSIONS: In the present study, we found that HT, OSAS, and previous CVA were independently correlated with the development of AF in the long-term follow-up of patients who underwent typical AFL ablation. We consider that AFL patients with such risk factors should be followed up closely following cavotricuspid isthmus ablation for the development of AF.
UNASSIGNED: HINTERGRUND: Vorhofflattern (VFL) und Vorhofflimmern (VF) sind die am häufigsten diagnostizierten supraventrikulären Arrhythmien und haben ähnliche pathophysiologische Mechanismen. Nach erfolgreicher Ablation des VFL tritt während des Langzeit-Follow-up oftmals VF auf. Wie in einigen Studien herausgestellt wurde, scheinen bestimmte Mechanismen für die Entstehung von VF bei VFL-Patienten zu prädisponieren, und bei annähernd 20% dieser Patienten besteht ein begleitendes VFL. ZIEL: Ziel der vorliegenden Arbeit war die Untersuchung unabhängiger Risikofaktoren, die Prädiktoren für die Entstehung von VF bei Patienten mit Ablation wegen typischem VFL sind.
METHODS: Es handelte sich um eine retrospektive multizentrische Querschnittstudie. Darin wurden retrospektiv 442 Patienten eingeschlossen, bei denen in 3 verschiedenen Zentren zwischen 1. Januar 2018 und 1. Januar 2022 eine Ablation wegen typischem VFL durchgeführt wurde. Nach der Ablation wurden die Patienten unterteilt in diejenigen, welche VF entwickelten, und diejenigen ohne VF. Im Durchschnitt wurden die Patienten 12 (4–20) Monate lang nachbeobachtet. In der Phase nach dem Eingriff wurden atriale Arrhythmien mittels 24-h-Langzeit-EKG und EKG nach einem Monat, 6 und 12 Monaten und danach in 6‑monatigen Abständen untersucht.
UNASSIGNED: Während des Langzeit-Follow-up trat ein VF bei 206 (46,6%) Patienten auf. Alter, Hypertonie (HT), obstruktives Schlafapnoesyndrom (OSAS), frühere zerebrovaskuläre Ereignisse (CVA), linksatrialer anteroposteriorer Durchmesser, schwere Mitralregurgitation, Hämoglobin‑, Blutzucker- und HbA1c-Wert wurden in der univariablen Analyse als signifikant eingestuft. Gemäß der multivariablen Analyse waren HT (p = 0,014; Hazard Ratio, HR: 1,483 [1,084–2,030]), OSAS (p = 0,008; HR: 1,520 [1,117–2,068]) und frühere CVA (p = 0,038; HR: 1,749 [1,031–2,968]) unabhängig mit der Entstehung von VF bei VFL-Patienten mit Zustand nach Ablation assoziiert.
UNASSIGNED: In der vorliegenden Studie stellte sich heraus, dass HT, OSAS und frühere CVA unabhängig mit der Entstehung von VF im Langzeit-Follow-up bei Patienten korreliert waren, bei denen eine Ablation wegen typischem VFL erfolgte. Den Autoren zufolge sollten VFL-Patienten mit solchen Risikofaktoren nach einer kavotrikuspidalen Isthmusablation engmaschig in Bezug auf die Entstehung von VF nachuntersucht werden.

Arrhythmias are highly prevalent in adults with congenital heart disease. For the clinician caring for this population, an understanding of pathophysiology, diagnosis, and management of arrhythmia is essential. Herein we review the latest updates in diagnostics and treatment of tachyarrhythmias and bradyarrhythmias, all in the context of congenital anatomy, hemodynamics, and standard invasive palliations for congenital heart disease.

UNASSIGNED: Supraventricular tachyarrhythmias (ST) are the most common cardiac arrhythmias. Little is known about the potential impact of demoralization, which is considered as partially distinct from depression, on the course of ST. A correct assessment of both depressive symptoms and demoralization appears relevant for the treatment of these cardiac diseases, potentially influencing their course.
UNASSIGNED: The sample consisted of 110 subjects affected by different ST, such as atrial fibrillation (AF), atrial flutter (AFL) and paroxysmal supraventricular tachycardia (PSVT). They all underwent a psychiatric evaluation; the Italian version of 9-item Patient Health Questionnaire (PHQ-9) and the Italian version of Demoralization Scale (DS) were administered. Descriptive statistics, pairwise comparisons, and correlational analysis have been implemented.
UNASSIGNED: 26 individuals (23.6%) presented high levels of demoralization. Of these, 20 (76.9%) had a diagnosis of AF and six patients (23.1%) received a diagnosis of other ST. No differences in demoralization levels resulted in regard of sex, cardiac diagnoses and anticoagulant therapies. Amongst people with high levels of demoralization, 13 (50%) received no formal psychiatric diagnosis, and 12 (46.2%) showed moderate/severe depressive symptoms. Demoralization levels and PHQ-9 scores showed a significant positive correlation in the whole sample (r=0.550, p<0.001).
UNASSIGNED: The present study found that in a sample of patients suffering from ST, high levels of demoralization were more frequent than clinically relevant depressive symptoms. We propose that demoralization and depression show partially distinguished psychopathological features, potentially associated with different therapeutic trajectories.

暂无摘要。

BACKGROUND: Although radiofrequency ablation of the cavotricuspid isthmus (CTI), responsible for sustaining atrial flutter, is a highly effective procedure, in extended patients\' observations following this procedure, more than every tenth becomes unsuccessful. Therefore, this study aimed to provide helpful information about the anatomy of the CTI in transthoracic echocardiography, which can aid in better planning of the CTI radiofrequency ablation in patients with typical atrial flutter.
METHODS: 56 patients with typical atrial flutter after radiofrequency ablation were evaluated at the end of the 24-month observation period. With substernal modified transthoracic echocardiographic (mTTE) evaluation, we identified four main anatomical obstacles impeding radiofrequency ablation. These obstacles were tricuspid annular plane systolic excursion, cavotricuspid isthmus length, cavotricuspid isthmus morphology, and the presence of a prominent Eustachian ridge/Eustachian valve. All intraprocedural radiofrequency ablation data were collected for analysis and correlated with anatomical data.
RESULTS: In the 24-month observation period, freedom from atrial flutter was 67.86%. The mean length of the isthmus was 30.34 ± 6.67 mm. The isthmus morphology in 56 patients was categorized as flat (n = 27; 48.2%), concave (n = 10; 17.85%), and pouch (n = 19, 33.9%). A prominent Eustachian ridge was observed in 23 patients (41.1%). Lack of anatomical obstacles in mTTE evaluation resulted in 100% efficacy, while the presence of at least two obstacles significantly increased the risk of unsuccessful ablation with more than two (OR 12.31 p = 0.01). Generally, 8 mm electrodes were the most effective for non-difficult CTI, while 3.5 mm electrodes used with a 3D system had highest performance for complex CTI. Notably, aging was the only factor that worsened the long-term outcome (OR 1.07 p = 0.044).
CONCLUSIONS: Preoperative usage of mTTE evaluation helps predict difficulty in cavotricuspid isthmus radiofrequency ablation, thus allowing better planning of the radiofrequency ablation strategy using the most accurate radiofrequency ablation electrode.

暂无摘要。

Atrial flutter is a supraventricular cardiac arrhythmia commonly characterized by two or three rapid atrial contractions for every ventricular contraction and a rapid ventricular rate that can be identified by a sawtooth pattern on an electrocardiogram. Patients often present with symptoms of heart failure and face the risk of atrial thrombus with a potential for systemic embolization. As such, pharmacologic rate and rhythm control, transesophageal echocardiogram, direct current cardioversion, and anticoagulation therapies may all be required for patient management. This case study provides an example of the patient presentation, exam findings, diagnostic results, and intervention modalities required for the health care provider to manage atrial flutter correctly in the emergency department setting.

Limited comparative data exist regarding the risk of cardiogenic emboli in patients with isolated atrial flutter (AFL) Some studies suggest a lower complication risk in AFL compared to atrial fibrillation (Afib), but methodological limitations and conflicting reports necessitate a comprehensive investigation. Our analysis proposes that isolated AFL carries a lower risk of ischemic events and left atrial thrombus formation than AFib. Importantly, we caution against applying stroke risk assessment approaches designed for AFib to AFL patients, as it may lead to harmful overestimations and unnecessary anticoagulant prescriptions. Furthermore, we highlight the current lack of sufficient data to determine the overall clinical benefit of prolonged anticoagulant therapy in patients with isolated AFL, especially when CHA2DS2-VASc index values are below 4. This review challenges existing perceptions, offering insights into the nuanced risk profiles of the transitional nature of isolated AFL due to the high incidence of AFib development within a year of AFL diagnosis. Tailored risk assessments and further research are essential for precise clinical decision-making in this dynamic landscape.