Correlative anatomy and electrophysiology for the interventional electrophysiologist: Right atrial flutter

Research output: Contribution to journalReview articlepeer-review

57 Scopus citations


Anatomy of Right Atrial Flutter. The cavotricuspid isthmus (CVTI) is the well-established location of atrial tissue critical for the maintenance of typical atrial flutter. The CVTI begins at the electrically inert tricuspid valve and includes the atrial myocardium up to the inferior vena cava (IVC). In this article, we discuss relevant CVTI and right atrial anatomy of interest to the electrophysiologist. Critical questions that are considered include why ablation is sometimes difficult across the CVTI and how best to deal with anatomic variation including sub-Eustachian pouches or large pectinate muscles encroaching onto the isthmus. Important electroanatomic features of the right atrium (RA) including sites for naturally occurring conduction block and the anatomy of the "lower loop" are reviewed. Following this discussion on the impact of the underlying anatomy for right atrial flutter ablation, an approach to dealing with difficulty when mapping or ablating this common arrhythmia is presented.

Original languageEnglish (US)
Pages (from-to)113-122
Number of pages10
JournalJournal of cardiovascular electrophysiology
Issue number1
StatePublished - Jan 2009


  • Ablation
  • Anatomy
  • Atrial flutter
  • Cavotricuspid isthmus
  • Crista terminalis
  • Electrophysiology
  • Typical flutter

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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