Person:
Pérez Villacastín Domínguez, Julián

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First Name
Julián
Last Name
Pérez Villacastín Domínguez
URI
https://hdl.handle.net/20.500.14352/79096
Affiliation
Universidad Complutense de Madrid
Faculty / Institute
Medicina
Department
Medicina
Area
Medicina
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19991
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    Rate-dependent conduction block of the crista terminalis in patients with typical atrial flutter: Influence on evaluation of cavotricuspid isthmus conduction block
    (Circulation, 1999) Arenal, Ángel; Almendral Garrote, Jesús; Alday, Jesús M.; Pérez Villacastín Domínguez, Julián; Ormaetxe, José M.; Martínez Sande, José Luis; Pérez Castellano, Nicasio; González, Sergio; Ortiz, Mercedes; Delcán Domínguez, Juan Luis
    Background: The crista terminalis (CT) has been identified as the posterior boundary of typical atrial flutter (AFL) in the lateral wall (LW) of the right atrium (RA). To study conduction properties across the CT, rapid pacing was performed at both sides of the CT after bidirectional conduction block was achieved in the cavotricuspid isthmus by radiofrequency catheter ablation. Methods and results: In 22 patients (aged 61+/-7 years) with AFL (cycle length, 234+/-23 ms), CT was identified during AFL by double electrograms recorded between the LW and posterior wall (PW). After the ablation procedure, decremental pacing trains were delivered from 600 ms to 2-to-1 local capture at the LW and PW or coronary sinus ostium (CSO). At least 5 bipolar electrograms were recorded along the CT from the high to the low atrium next to the inferior vena cava. No double electrograms were recorded during sinus rhythm in that area. Complete transversal conduction block all along the CT (detected by the appearance of double electrograms at all recording sites and craniocaudal activation sequence on the side opposite to the pacing site) was observed in all patients during pacing from the PW or CSO (cycle length, 334+/-136 ms), but it was fixed in only 4 patients. During pacing from the LW, complete block appeared at a shorter pacing cycle length (281+/-125 ms; P<0.01) and was fixed in 2 patients. In 3 patients, complete block was not achieved. Conclusions: These data suggest the presence of rate-dependent transversal conduction block at the crista terminalis in patients with typical AFL. Block is usually observed at longer pacing cycle lengths with PW pacing than with LW pacing. This difference may be a critical determinant of the counterclockwise rotation of typical AFL