![]() ![]() The flatter portion of the atrial flutter wave corresponds to activation of the cavotricuspid isthmus which has little myocardial mass. In this case, there are silent periods because of constant activation. Schematic representation of the atrial activation sequence in typical atrial flutter in relation to the atrial flutter wave in lead II. ![]() 1 Alternating P waves and a stable baseline on ECG indicate that the tachycardia is the focal mechanism with silent periods between focal discharges ( Figure 2), but there are exceptions to this rule.įigure 3. Electrocardiographic diagnosis Focal Atrial Tachycardiaįocal atrial tachycardia (FAT) is defined as a rapid atrial rhythm, regular, not originating from the sinus node, with stable P-wave morphology on ECG and that only requires atrial structures to be maintained ( Figure 1). In this review, we provide a perspective on atrial tachycardias in a clinical setting, linking clinical manifestations to electrophysiological mechanisms and pathogenic substrates to establish prognoses and make rational therapeutic decisions. On the other hand, cardiac surgery, particularly congenital heart disease surgery, and more recently some radiofrequency ablation treatments, are showing striking arrhythmogenic potential that may lead to a new generation of iatrogenic tachycardias that could be problematic in the future. ![]() Electrocardiogram (ECG) analysis had already led to a classification based on pathogenic hypotheses, but atrial activation mapping and the study of stimulation responses have allowed a more accurate definition of the mechanisms and their anatomic substrates, enabling a “curative” approach using catheter ablation or surgery in many cases. Since the 1970s, knowledge of the mechanisms and pathologic substrates of atrial tachycardias has evolved within the setting of clinical electrophysiology. Algunos de los conceptos expuestos son complejos, pero creemos que es necesario apuntar la perspectiva de los métodos electrofisiológicos que permiten dibujar las bases anatómicas de las arritmias, que hoy resultan más fácilmente comprensibles gracias a la construcción de moldes anatómicos con sistemas computarizados de navegación. En esta revisión se dibuja el panorama actual de los mecanismos de taquicardias auriculares, tanto focales como reentrantes, procurando establecer lazos con los conceptos clásicos que permitan al clínico enfrentarse a los diagnósticos diferenciales y hacer las indicaciones correctas de tratamiento, incluido el estudio electrofisiológico. La clasificación tradicional que distingue la taquicardia auricular del aleteo auricular basándose en criterios de frecuencia y morfología de ondas ha dejado de ser relevante, en un momento en que el desarrollo de la electrofisiología clínica puede permitir una intervención curativa sobre la arritmia, basada en su mecanismo, y se hace muy necesario acercar la experiencia del laboratorio a la clínica. Some of the concepts may seem complex, but we thought it important to provide an overview of the electrophysiological methods that may eventually lead to the description of the anatomic bases of the arrhythmias currently, these are easier to understand thanks to the virtual anatomic casts built using computerized navigation systems.Įn el año 2009 se llevaron a cabo en España 2.343 procedimientos de ablación con catéter de aleteo, taquicardia macrorreentrante atípica o taquicardia auricular focal, con un crecimiento del 8% sobre el año anterior, lo que da una idea de la importancia clínica de estas arritmias. In this review we outline our present understanding of atrial tachycardia mechanisms, both focal and macroreentrant, and attempt to establish the conceptual links with classic concepts that may help the clinician to make a differential diagnosis and establish therapeutic indications, including that of an electrophysiologic study. The classic categorization of atrial tachycardia and atrial flutter based on rate and morphological criteria has become almost irrelevant at a time when clinical electrophysiology may lead to curative intervention based on a definition of the mechanism, making it necessary to bring laboratory experience closer to clinical practice. In 2009, 2343 catheter ablation procedures were performed in Spain for focal atrial tachycardia or atrial flutter (typical and atypical), with a yearly growth rate of 8%, indicating the clinical importance of these arrhythmias. ![]()
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