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Catheter ablation flutter11/22/2023 ![]() ![]() We also are able to utilize the most advanced mapping systems. Although this procedure is considered curative, one-third of AFL patients have significant risk of developing atrial fibrillation (AF) 2 that along with coexistent AFL increases risk of developing serious symptoms 3. We are one of only a handful of centers in the United States that provide a complete suite of approaches to AFib, including hybrid procedures with epicardial robotic surgery in conjunction with endocardial ablation. Catheter ablation is a commonly performed procedure to achieve rhythm control in patients with typical atrial flutter (AFL) 1. Current research seeks to understand the mechanisms of atrial fibrillation, which appear to come from multiple areas at the same time.Īt the University of Chicago Medicine, our team uses special catheters that allow them to know how much force is being applied onto the tissue, which has been shown to improve the success rate for the procedure. We start with the initial set of treatments and then we get more aggressive as the pest problem declares itself to be more and more stubborn. We come in and we do a treatment and we can control the cases but frequently it requires multiple treatments. We give patients the analogy that atrial fibrillation is like a pest problem in your home. The ECG in Acute MI.Similar to atrial flutter, treatment options for AFib include anticoagulation (blood thinners) and controlling the arrhythmia with medication or catheter ablation therapy.Īblation is also effective in 60% to 70% of AFib patients. ECG in Emergency Medicine and Acute Care 1e, 2004 ECG’s for the Emergency Physician Part I 1e, 2003 and Part II Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric 6e, 2008 Critical Decisions in Emergency and Acute Care Electrocardiography 1e, 2009 Marriott’s Practical Electrocardiography 13e, 2021 Electrocardiography in Emergency, Acute, and Critical Care. ECG Mastery: Blue Belt online course: Become an ECG expert. Similar mechanisms exist for the other types of AVNRT.This most common type of re-entrant circuit is termed Slow-Fast AVNRT.The short cycle length is responsible for the rapid heart rate.This creates a circus movement whereby the impulse continually cycles around the two pathways, activating the Bundle of His anterogradely and the atria retrogradely (3).By the time the premature impulse reaches the end of the slow pathway, the fast pathway is no longer refractory, and the impulse is permitted to recycle retrogradely up the fast pathway (2).However, if a premature atrial contraction (PAC) arrives while the fast pathway is still refractory, the electrical impulse will be directed solely down the slow pathway (1).The impulse transmitted down the fast pathway enters the distal end of the slow pathway and the two impulses cancel each other out During normal sinus rhythm, electrical impulses travel down both pathways simultaneously.Mechanism of re-entry in “slow-fast” AVNRT:ġ) A premature atrial contraction (PAC) arrives while the fast pathway is still refractory, and is directed down the slow pathwayĢ) The ERP in the fast pathway ends, and the PAC impulse travels retrogradely up the fast pathwayģ) The impulse continually cycles around the two pathways Initiation of re-entry In comparison to AVRT, which involves an anatomical re-entry circuit (Bundle of Kent), in AVNRT there is a functional re-entry circuit within the AV node. The condition is generally well tolerated and is rarely life threatening in patients with pre-existing heart disease.It may self-resolve or continue indefinitely until medical treatment is sought The tachycardia typically ranges between 140-280 bpm and is regular in nature.Rarely, polyuria due to elevated atrial pressures causing release of atrial natriuretic peptide.Chest pain, especially in the context of underlying coronary artery disease.Presyncope or syncope due to a transient fall in blood pressure.Patients will typically complain of the sudden onset of rapid, regular palpitations.It is more common in women than men (~ 75% of cases occurring in women) and may occur in young and healthy patients as well as those suffering chronic heart disease.AVNRT is typically paroxysmal and may occur spontaneously or upon provocation with exertion, caffeine, alcohol, beta-agonists (salbutamol) or sympathomimetics (amphetamines).This is the commonest cause of palpitations in patients with structurally normal hearts.
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