The positive F wave in lead V1 of typical atrial flutter is caused by activation of the right atrial appendage: Insight from mapping during entrainment from the right atrial appendage
Introduction Typical atrial flutter (AFL) is a macroreentrant tachycardia in which intracardiac conduction rotates counterclockwise around the tricuspid annulus. Typical AFL has specific electrocardiographic characteristics, including a negative sawtooth‐like wave in the inferior lead and a positive...
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| Veröffentlicht in: | Journal of cardiovascular electrophysiology 2024-11, Vol.35 (11), p.2211-2219 |
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| creator | Yamashita, Shu Mizukami, Akira Ono, Maki Hiroki, Jiro Miyakuni, Shota Arashiro, Takumi Ueshima, Daisuke Matsumura, Akihiko Miyazaki, Shinsuke Sasano, Tetsuo |
| description | Introduction
Typical atrial flutter (AFL) is a macroreentrant tachycardia in which intracardiac conduction rotates counterclockwise around the tricuspid annulus. Typical AFL has specific electrocardiographic characteristics, including a negative sawtooth‐like wave in the inferior lead and a positive F wave in lead V1. This study aimed to analyze the origin of the positive F wave in lead V1, which has not been completely understood.
Methods
This study enrolled 10 patients who underwent radiofrequency catheter ablation for a typical AFL. Electroanatomical mapping was performed both during typical AFL and entrainment from the right atrial appendage (RAA). The 12‐lead electrocardiogram (ECG) and three‐dimensional (3D) electroanatomical maps were analyzed.
Results
The positive F wave in lead V1 changed during entrainment from the RAA in all the cases. The 3D map during entrainment from the RAA revealed an area of antidromic capture around the RAA, which collided with the orthodromic wave in the anterior right atrium. This area of antidromic capture around the RAA was the only difference from the 3D electroanatomical map of AFL and is considered the cause of the change in the F wave in lead V1 during entrainment.
Conclusion
The analysis of the differences in the 12‐lead ECG and 3D maps between tachycardia and entrainment from the RAA clearly demonstrated that activation around the RAA is responsible for the generation of the positive F wave in lead V1 of typical AFL.
The positive F wave in lead V1 changed during entrainment from the right atrial appendage (RAA) during typical atrial flutter (AFL). The 3‐dimensional (3D) electroanatomical map during entrainment from the RAA revealed an area of antidromic capture around the RAA, which was the only difference from the 3D electroanatomical map of typical AFL, proving that the activation around the RAA is responsible for the generation of the positive F wave in lead V1 of typical AFL. |
| doi_str_mv | 10.1111/jce.16436 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3109976626</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3124278807</sourcerecordid><originalsourceid>FETCH-LOGICAL-c2786-faae1c2c9e9912fee27ad41f545d4d07817c124589027ca32e7ef2f34c2758213</originalsourceid><addsrcrecordid>eNp1kc1O3TAUhK2Kqvy0C14AWWLTLgL-S5ywq66AUiF1Q7uNDs7xxVeJE2yn6D5ZX6_mBrqohDdjab4ZHWkIOebsjOd3vjF4xislq3fkgJeKFTWv9F7-M1UWstZynxzGuGGMy4qVH8i-bKRQdckOyJ-7B6TTGF1yv5Fe0SfI4jztETr6i9PR0rSdnIGeQgoui-3nlDBQF6mBOWJH77cUTM5DcqPfJXJncOuH9JqBaULfwRov6I2PO8eGcaBDNpxf024Oz4I-BXB-yLr4bxd9JO8t9BE_vegR-Xl1ebf6Vtz-uL5Zfb0tjNB1VVgA5EaYBpuGC4soNHSK21KVneqYrrk2XKiybpjQBqRAjVZYqXK8rAWXR-Tz0juF8XHGmNrBRYN9Dx7HObaSs6bRVSWqjJ7-h27GOfh8XaaEyvfUTGfqy0KZMMYY0LZTcAOEbctZ-7xmm9dsd2tm9uSlcb4fsPtHvs6XgfMFeHI9bt9uar-vLpfKv45uqt4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3124278807</pqid></control><display><type>article</type><title>The positive F wave in lead V1 of typical atrial flutter is caused by activation of the right atrial appendage: Insight from mapping during entrainment from the right atrial appendage</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Yamashita, Shu ; Mizukami, Akira ; Ono, Maki ; Hiroki, Jiro ; Miyakuni, Shota ; Arashiro, Takumi ; Ueshima, Daisuke ; Matsumura, Akihiko ; Miyazaki, Shinsuke ; Sasano, Tetsuo</creator><creatorcontrib>Yamashita, Shu ; Mizukami, Akira ; Ono, Maki ; Hiroki, Jiro ; Miyakuni, Shota ; Arashiro, Takumi ; Ueshima, Daisuke ; Matsumura, Akihiko ; Miyazaki, Shinsuke ; Sasano, Tetsuo</creatorcontrib><description>Introduction
Typical atrial flutter (AFL) is a macroreentrant tachycardia in which intracardiac conduction rotates counterclockwise around the tricuspid annulus. Typical AFL has specific electrocardiographic characteristics, including a negative sawtooth‐like wave in the inferior lead and a positive F wave in lead V1. This study aimed to analyze the origin of the positive F wave in lead V1, which has not been completely understood.
Methods
This study enrolled 10 patients who underwent radiofrequency catheter ablation for a typical AFL. Electroanatomical mapping was performed both during typical AFL and entrainment from the right atrial appendage (RAA). The 12‐lead electrocardiogram (ECG) and three‐dimensional (3D) electroanatomical maps were analyzed.
Results
The positive F wave in lead V1 changed during entrainment from the RAA in all the cases. The 3D map during entrainment from the RAA revealed an area of antidromic capture around the RAA, which collided with the orthodromic wave in the anterior right atrium. This area of antidromic capture around the RAA was the only difference from the 3D electroanatomical map of AFL and is considered the cause of the change in the F wave in lead V1 during entrainment.
Conclusion
The analysis of the differences in the 12‐lead ECG and 3D maps between tachycardia and entrainment from the RAA clearly demonstrated that activation around the RAA is responsible for the generation of the positive F wave in lead V1 of typical AFL.
The positive F wave in lead V1 changed during entrainment from the right atrial appendage (RAA) during typical atrial flutter (AFL). The 3‐dimensional (3D) electroanatomical map during entrainment from the RAA revealed an area of antidromic capture around the RAA, which was the only difference from the 3D electroanatomical map of typical AFL, proving that the activation around the RAA is responsible for the generation of the positive F wave in lead V1 of typical AFL.</description><identifier>ISSN: 1045-3873</identifier><identifier>ISSN: 1540-8167</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/jce.16436</identifier><identifier>PMID: 39324850</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Action Potentials ; Aged ; antidromic conduction ; Atrial Appendage - physiopathology ; Atrial Flutter - diagnosis ; Atrial Flutter - physiopathology ; Atrial Flutter - surgery ; Atrial Function, Right ; Cardiac arrhythmia ; Cardiac Pacing, Artificial ; Catheter Ablation ; EKG ; electrocardiogram ; Electrocardiography ; Electrophysiologic Techniques, Cardiac ; Entrainment ; Female ; Heart Rate ; Humans ; Male ; Mapping ; Middle Aged ; orthodromic conduction ; Predictive Value of Tests ; Tachycardia ; Time Factors ; Treatment Outcome ; typical atrial flutter</subject><ispartof>Journal of cardiovascular electrophysiology, 2024-11, Vol.35 (11), p.2211-2219</ispartof><rights>2024 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2786-faae1c2c9e9912fee27ad41f545d4d07817c124589027ca32e7ef2f34c2758213</cites><orcidid>0000-0002-0230-0934 ; 0000-0003-3582-6104 ; 0000-0002-6765-0185</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjce.16436$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjce.16436$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39324850$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yamashita, Shu</creatorcontrib><creatorcontrib>Mizukami, Akira</creatorcontrib><creatorcontrib>Ono, Maki</creatorcontrib><creatorcontrib>Hiroki, Jiro</creatorcontrib><creatorcontrib>Miyakuni, Shota</creatorcontrib><creatorcontrib>Arashiro, Takumi</creatorcontrib><creatorcontrib>Ueshima, Daisuke</creatorcontrib><creatorcontrib>Matsumura, Akihiko</creatorcontrib><creatorcontrib>Miyazaki, Shinsuke</creatorcontrib><creatorcontrib>Sasano, Tetsuo</creatorcontrib><title>The positive F wave in lead V1 of typical atrial flutter is caused by activation of the right atrial appendage: Insight from mapping during entrainment from the right atrial appendage</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>Introduction
Typical atrial flutter (AFL) is a macroreentrant tachycardia in which intracardiac conduction rotates counterclockwise around the tricuspid annulus. Typical AFL has specific electrocardiographic characteristics, including a negative sawtooth‐like wave in the inferior lead and a positive F wave in lead V1. This study aimed to analyze the origin of the positive F wave in lead V1, which has not been completely understood.
Methods
This study enrolled 10 patients who underwent radiofrequency catheter ablation for a typical AFL. Electroanatomical mapping was performed both during typical AFL and entrainment from the right atrial appendage (RAA). The 12‐lead electrocardiogram (ECG) and three‐dimensional (3D) electroanatomical maps were analyzed.
Results
The positive F wave in lead V1 changed during entrainment from the RAA in all the cases. The 3D map during entrainment from the RAA revealed an area of antidromic capture around the RAA, which collided with the orthodromic wave in the anterior right atrium. This area of antidromic capture around the RAA was the only difference from the 3D electroanatomical map of AFL and is considered the cause of the change in the F wave in lead V1 during entrainment.
Conclusion
The analysis of the differences in the 12‐lead ECG and 3D maps between tachycardia and entrainment from the RAA clearly demonstrated that activation around the RAA is responsible for the generation of the positive F wave in lead V1 of typical AFL.
The positive F wave in lead V1 changed during entrainment from the right atrial appendage (RAA) during typical atrial flutter (AFL). The 3‐dimensional (3D) electroanatomical map during entrainment from the RAA revealed an area of antidromic capture around the RAA, which was the only difference from the 3D electroanatomical map of typical AFL, proving that the activation around the RAA is responsible for the generation of the positive F wave in lead V1 of typical AFL.</description><subject>Action Potentials</subject><subject>Aged</subject><subject>antidromic conduction</subject><subject>Atrial Appendage - physiopathology</subject><subject>Atrial Flutter - diagnosis</subject><subject>Atrial Flutter - physiopathology</subject><subject>Atrial Flutter - surgery</subject><subject>Atrial Function, Right</subject><subject>Cardiac arrhythmia</subject><subject>Cardiac Pacing, Artificial</subject><subject>Catheter Ablation</subject><subject>EKG</subject><subject>electrocardiogram</subject><subject>Electrocardiography</subject><subject>Electrophysiologic Techniques, Cardiac</subject><subject>Entrainment</subject><subject>Female</subject><subject>Heart Rate</subject><subject>Humans</subject><subject>Male</subject><subject>Mapping</subject><subject>Middle Aged</subject><subject>orthodromic conduction</subject><subject>Predictive Value of Tests</subject><subject>Tachycardia</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>typical atrial flutter</subject><issn>1045-3873</issn><issn>1540-8167</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc1O3TAUhK2Kqvy0C14AWWLTLgL-S5ywq66AUiF1Q7uNDs7xxVeJE2yn6D5ZX6_mBrqohDdjab4ZHWkIOebsjOd3vjF4xislq3fkgJeKFTWv9F7-M1UWstZynxzGuGGMy4qVH8i-bKRQdckOyJ-7B6TTGF1yv5Fe0SfI4jztETr6i9PR0rSdnIGeQgoui-3nlDBQF6mBOWJH77cUTM5DcqPfJXJncOuH9JqBaULfwRov6I2PO8eGcaBDNpxf024Oz4I-BXB-yLr4bxd9JO8t9BE_vegR-Xl1ebf6Vtz-uL5Zfb0tjNB1VVgA5EaYBpuGC4soNHSK21KVneqYrrk2XKiybpjQBqRAjVZYqXK8rAWXR-Tz0juF8XHGmNrBRYN9Dx7HObaSs6bRVSWqjJ7-h27GOfh8XaaEyvfUTGfqy0KZMMYY0LZTcAOEbctZ-7xmm9dsd2tm9uSlcb4fsPtHvs6XgfMFeHI9bt9uar-vLpfKv45uqt4</recordid><startdate>202411</startdate><enddate>202411</enddate><creator>Yamashita, Shu</creator><creator>Mizukami, Akira</creator><creator>Ono, Maki</creator><creator>Hiroki, Jiro</creator><creator>Miyakuni, Shota</creator><creator>Arashiro, Takumi</creator><creator>Ueshima, Daisuke</creator><creator>Matsumura, Akihiko</creator><creator>Miyazaki, Shinsuke</creator><creator>Sasano, Tetsuo</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0230-0934</orcidid><orcidid>https://orcid.org/0000-0003-3582-6104</orcidid><orcidid>https://orcid.org/0000-0002-6765-0185</orcidid></search><sort><creationdate>202411</creationdate><title>The positive F wave in lead V1 of typical atrial flutter is caused by activation of the right atrial appendage: Insight from mapping during entrainment from the right atrial appendage</title><author>Yamashita, Shu ; Mizukami, Akira ; Ono, Maki ; Hiroki, Jiro ; Miyakuni, Shota ; Arashiro, Takumi ; Ueshima, Daisuke ; Matsumura, Akihiko ; Miyazaki, Shinsuke ; Sasano, Tetsuo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2786-faae1c2c9e9912fee27ad41f545d4d07817c124589027ca32e7ef2f34c2758213</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Action Potentials</topic><topic>Aged</topic><topic>antidromic conduction</topic><topic>Atrial Appendage - physiopathology</topic><topic>Atrial Flutter - diagnosis</topic><topic>Atrial Flutter - physiopathology</topic><topic>Atrial Flutter - surgery</topic><topic>Atrial Function, Right</topic><topic>Cardiac arrhythmia</topic><topic>Cardiac Pacing, Artificial</topic><topic>Catheter Ablation</topic><topic>EKG</topic><topic>electrocardiogram</topic><topic>Electrocardiography</topic><topic>Electrophysiologic Techniques, Cardiac</topic><topic>Entrainment</topic><topic>Female</topic><topic>Heart Rate</topic><topic>Humans</topic><topic>Male</topic><topic>Mapping</topic><topic>Middle Aged</topic><topic>orthodromic conduction</topic><topic>Predictive Value of Tests</topic><topic>Tachycardia</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>typical atrial flutter</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yamashita, Shu</creatorcontrib><creatorcontrib>Mizukami, Akira</creatorcontrib><creatorcontrib>Ono, Maki</creatorcontrib><creatorcontrib>Hiroki, Jiro</creatorcontrib><creatorcontrib>Miyakuni, Shota</creatorcontrib><creatorcontrib>Arashiro, Takumi</creatorcontrib><creatorcontrib>Ueshima, Daisuke</creatorcontrib><creatorcontrib>Matsumura, Akihiko</creatorcontrib><creatorcontrib>Miyazaki, Shinsuke</creatorcontrib><creatorcontrib>Sasano, Tetsuo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yamashita, Shu</au><au>Mizukami, Akira</au><au>Ono, Maki</au><au>Hiroki, Jiro</au><au>Miyakuni, Shota</au><au>Arashiro, Takumi</au><au>Ueshima, Daisuke</au><au>Matsumura, Akihiko</au><au>Miyazaki, Shinsuke</au><au>Sasano, Tetsuo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The positive F wave in lead V1 of typical atrial flutter is caused by activation of the right atrial appendage: Insight from mapping during entrainment from the right atrial appendage</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2024-11</date><risdate>2024</risdate><volume>35</volume><issue>11</issue><spage>2211</spage><epage>2219</epage><pages>2211-2219</pages><issn>1045-3873</issn><issn>1540-8167</issn><eissn>1540-8167</eissn><abstract>Introduction
Typical atrial flutter (AFL) is a macroreentrant tachycardia in which intracardiac conduction rotates counterclockwise around the tricuspid annulus. Typical AFL has specific electrocardiographic characteristics, including a negative sawtooth‐like wave in the inferior lead and a positive F wave in lead V1. This study aimed to analyze the origin of the positive F wave in lead V1, which has not been completely understood.
Methods
This study enrolled 10 patients who underwent radiofrequency catheter ablation for a typical AFL. Electroanatomical mapping was performed both during typical AFL and entrainment from the right atrial appendage (RAA). The 12‐lead electrocardiogram (ECG) and three‐dimensional (3D) electroanatomical maps were analyzed.
Results
The positive F wave in lead V1 changed during entrainment from the RAA in all the cases. The 3D map during entrainment from the RAA revealed an area of antidromic capture around the RAA, which collided with the orthodromic wave in the anterior right atrium. This area of antidromic capture around the RAA was the only difference from the 3D electroanatomical map of AFL and is considered the cause of the change in the F wave in lead V1 during entrainment.
Conclusion
The analysis of the differences in the 12‐lead ECG and 3D maps between tachycardia and entrainment from the RAA clearly demonstrated that activation around the RAA is responsible for the generation of the positive F wave in lead V1 of typical AFL.
The positive F wave in lead V1 changed during entrainment from the right atrial appendage (RAA) during typical atrial flutter (AFL). The 3‐dimensional (3D) electroanatomical map during entrainment from the RAA revealed an area of antidromic capture around the RAA, which was the only difference from the 3D electroanatomical map of typical AFL, proving that the activation around the RAA is responsible for the generation of the positive F wave in lead V1 of typical AFL.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>39324850</pmid><doi>10.1111/jce.16436</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-0230-0934</orcidid><orcidid>https://orcid.org/0000-0003-3582-6104</orcidid><orcidid>https://orcid.org/0000-0002-6765-0185</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Action Potentials Aged antidromic conduction Atrial Appendage - physiopathology Atrial Flutter - diagnosis Atrial Flutter - physiopathology Atrial Flutter - surgery Atrial Function, Right Cardiac arrhythmia Cardiac Pacing, Artificial Catheter Ablation EKG electrocardiogram Electrocardiography Electrophysiologic Techniques, Cardiac Entrainment Female Heart Rate Humans Male Mapping Middle Aged orthodromic conduction Predictive Value of Tests Tachycardia Time Factors Treatment Outcome typical atrial flutter |
| title | The positive F wave in lead V1 of typical atrial flutter is caused by activation of the right atrial appendage: Insight from mapping during entrainment from the right atrial appendage |
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