8/11/2023 0 Comments Cpt code atrial flutter ablationThe diagnosis of CTI-dependent atrial flutter is made by demonstration of macroreentry around the TVA during entrainment at two or more sites around the tricuspid valve, and demonstration of concealed entrainment from the CTI during AFL. The mechanism of most cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) is macroreentry around the tricuspid valve annulus (TVA). This chapter reviews the electrophysiology of CTI-dependent AFL and the techniques currently used for its diagnosis, mapping, and ablation. Although several approaches have been described for ablating CTI-dependent AFL, the most widely accepted technique is an anatomically-guided approach targeting the entire CTI, resulting in a high efficacy rate for cure of AFL, with minimal risk. Because of its well-defined anatomic substrate and frequent pharmacologic resistance, radiofrequency (RF) catheter ablation has been established as a safe and effective first-line treatment for CTI-dependent AFL. AFL is also relatively resistant to pharmacologic suppression. The triggers of AFL, commonly premature atrial contractions or nonsustained atrial fibrillation originating from the left atrium and pulmonary veins, most likely account for the fact that counterclockwise AFL (typical AFL) occurs most frequently clinically. This electrophysiologic milieu produces a long enough reentrant path length, relative to the average tissue wavelength around the TVA annulus, to allow for sustained reentry. CTI-dependent AFL has been shown to be caused by macroreentry around the tricuspid valve annulus (TVA), with an area of concealed conduction in the CTI, anatomically bounded by the TVA anteriorly and the inferior vena cava (IVC) and Eustachian ridge posteriorly, with a line of conduction block along the crista terminalis. Cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) is a common atrial arrhythmia, often occurring in association with atrial fibrillation, that may cause significant symptoms because of a rapid ventricular response, and it may cause embolic stroke, and rarely a tachycardia-induced cardiomyopathy.
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