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Ryckman N, Crinion D, Enriquez A, Bakker D, Chacko S, Abdollah H, Baranchuk A, Simpson C, Redfearn DP. Right atrial collision time (RACT): A novel marker of propensity for typical atrial flutter. J Cardiovasc Electrophysiol 2023; 34:1377-1383. [PMID: 37222182 DOI: 10.1111/jce.15935] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/28/2023] [Accepted: 05/04/2023] [Indexed: 05/25/2023]
Abstract
INTRODUCTION The risk of typical atrial flutter (AFL) is increased proportionately to right atrial (RA) size or right atrial scarring that results in reduced conduction velocity. These characteristics result in propagation of a flutter wave by ensuring the macro re-entrant wave front does not meet its refractory tail. The time taken to traverse the circuit would take account of both of these characteristics and may provide a novel marker of propensity to develop AFL. Our goal was to investigate right atrial collision time (RACT) as a marker of existing typical AFL. METHODS This single-centre, prospective study recruited consecutive typical AFL ablation patients that were in sinus rhythm. Controls were consecutive electrophysiology study patients >18 years of age. While pacing the coronary sinus (CS) ostium at 600 ms, a local activation time map was created to locate the latest collision point on the anterolateral right atrial wall. This RACT is a measure of conduction velocity and distance from CS to a collision point on the lateral right atrial wall. RESULTS Ninety-eight patients were included in the analysis, 41 with atrial flutter and 57 controls. Patients with atrial flutter were older, 64.7 ± 9.7 versus 52.4 ± 16.8 years (<.001), and more often male (34/41 vs. 31/57 [.003]). The AFL group mean RACT (132.6 ± 17.3 ms) was significantly longer than that of controls (99.1 ± 11.6 ms) (p < .001). A RACT cut-off of 115.5 ms had a sensitivity and specificity of 92.7% and 93.0%, respectively for diagnosis of atrial flutter. A ROC curve indicated an AUC of 0.96 (95% CI: 0.93-1.0, p < .01). CONCLUSION RACT is a novel and promising marker of propensity for typical AFL. This data will inform larger prospective studies.
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Affiliation(s)
- Nick Ryckman
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Derek Crinion
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Andres Enriquez
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - David Bakker
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Sanoj Chacko
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Hoshiar Abdollah
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Christopher Simpson
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Damian P Redfearn
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
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