J Med Assoc Thai 1997; 80 (7):466

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Radiofrequency Catheter Ablation in Type I Atrial Flutter : Preliminary Experience of 10 Cases
Raungratanaamporn O Mail, Bhuripanyo K , Krittayaphong R , Aroonpruksakul S , Toomtong P , Chaithiraphan S

Common atrial flutter results from macroreentry in the right atrium. Catheter ablation of
slow conduction, between tricuspid annulus and inferior vena cava (TA-IVC) or tricuspid annulus
and coronary sinus ostium (TA-CS os) has been reported to terminate and prevent recurrence of this
arrhythmia. We reported 10 consecutive patients, 7 men and 3 women, who underwent radiofrequency
catheter ablation of common atrial flutter. The mean age was 59.4 ± 11.2 years (range
42 - 82 years). During the paroxysmal atrial flutter, all patients had palpitation, 4 had dyspnea on
exertion, 3 patients had syncope and 1 patient had presyncope. The mean duration of symptoms
was 5.7 ± 4.9 years (range 0.5 - 13 years). Two patients had dilated cardiomyopathy, 1 Ebstein's
anomaly and 1 chronic obstructive pulmonary disease. Four patients (40%) had history of atrial
fibrillation (AF) before ablation. The mean cycle length of atrial rhythm was 257.2 ± 36.6 ms.
Ablation was done by anatomical approach and could terminate arrhythmia in 9 patients (90% ), 7
from TA-IVC, 2 from TA-CS os without major complication. The mean number of applications was
20.4 ± 16.9 and turned atrial flutter to normal sinus rhythm in 13.5 ± 10.7 seconds. Fluoroscopic
and procedure times were 38.4 ± 31.4 and 157.2 ± 68.8 minutes, respectively. During the follow-up
period of 24.0 ± 28.7 weeks, 2 patients had recurrent atrial arrhythmia, 1 atrial fibrillation and 1
atrial flutter type I, giving the final success rate of 70 per cent. All patients who had recurrence or
failure had a history of paroxysmal AF before ablation.
In conclusion, radiofrequency catheter ablation in atrial flutter type I, using anatomical
approach, is an effective treatment to terminate and prevent this arrhythmia in short term
follow-up. It may be considered as an alternative treatment in patients with atrial flutter who were
refractory to antiarrhythmic agents.

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