{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:02:11Z","timestamp":1787014931406,"version":"build-2736575974"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2007,4,20]],"date-time":"2007-04-20T00:00:00Z","timestamp":1177027200000},"content-version":"vor","delay-in-days":3761,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[1997,1]]},"abstract":"<jats:p>\n                    RF Catheter Ablation of Clockwise Atrial Flutter.\n                    <jats:italic>introduction<\/jats:italic>\n                    : Although the mechanism and radiofrequency catheter ablation of counterclockwise (typical) atrial flutter have been studied extensively, information about the electrocardiographic and electropbysiologic characteristics and effects of radiofrequency ablation in patients with clockwise atrial flutter is limited.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Methods and Results<\/jats:italic>\n                    : Thirty consecutive patients with clinically documented paroxysmal clockwise atrial flutter were studied. Endocardial recordings and entrainment study using a \u201chalo\u201d catheter with 10 electrode pairs in the right atrium were performed. Radiofrequency energy was applied to the inferior vena cava\u2010tricuspid annulus (IVC\u2010TA) and\/or coronary sinus ostium\u2010tricuspid annulus (CSO\u2010TA) isthmus to evaluate the effects of linear catheter ablation. Eighteen patients had both counterclockwise and clockwise atrial flutters, and 12 patients had only clockwise atrial flutter. Both forms of atrial flutter had similar flutter cycle lengths (232 \u00b1 30 vs 226 \u00b1 25 msec, P = 0.526) but reverse activation sequences. Right atrial pacing at a cycle length 20 msec shorter than the flutter cycle length from the CSO\u2010TA isthmus, IVC\u2010TA isthmus, and the area between the two isthmuses revealed concealed entrainment with stimulus\u2010to\u2010P wave intervals of 32 \u00b1 19, 95 \u00b1 14, and 50 \u00b1 17 msec (P = 0.022) in the counterclockwise form, and 110 \u00b1 12, 40 \u00b1 20, and 60 \u00b1 15 msec (P = 0.018) in the clockwise form. In clockwise atrial flutter, 20 patients with biphasic P waves in the inferior leads had the presumed exit site of slow conduction area located at the low posterolateral right atrium; 10 patients with positive P waves in the inferior leads had the presumed exit site located at the mid\u2010high posterolateral right atrium. Among the 18 patients with both forms of atrial flutter, linear ablation lesions directed at the IVC\u2010TA isthmus eliminated both forms of atrial flutter in 14 patients; in the remaining 4 patients. CSO\u2010TA linear lesions eliminated the counterclockwise form and IVC\u2010TA lesions eliminated the clockwise form. Among the 12 patients with the clockwise form only, CSO\u2010TA linear lesions eliminated flutter in 2 and IVC\u2010TA linear lesions eliminated flutter in 10 patients. Successful ablation was confirmed by creation of bidirectional conduction block in the IVC\u2010TA and\/or CSO\u2010TA isthmus during pacing from the proximal coronary sinus and right posterolateral atrium sandwiching the linear lesions. During the follow\u2010up period of 17 \u00b1 8 months, 2 patients had recurrence of clockwise atrial flutter, 1 patient had new onset of atypical atrial flutter, and 2 patients had new onset of atrial fibrillation.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusions<\/jats:italic>\n                    : Counterclockwise and clockwise atrial flutters may have overlapping slow conduction areas with different exit sites. Radiofrequency catheter ablation using the linear method directed at the IVC\u2010TA and CSO\u2010TA isthmuses was feasible and effective in treating both forms of atrial flutter.\n                  <\/jats:p>","DOI":"10.1111\/j.1540-8167.1997.tb00605.x","type":"journal-article","created":{"date-parts":[[2007,4,20]],"date-time":"2007-04-20T11:15:10Z","timestamp":1177067710000},"page":"24-34","source":"Crossref","is-referenced-by-count":44,"title":["Electrophysiologic Characteristics and Radiofrequency Catheter Ablation in Patients with Clockwise Atrial Flutter"],"prefix":"10.1111","volume":"8","author":[{"given":"CHING\u2010TAI","family":"TAI","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SHIH\u2010ANN","family":"CHEN","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CHERN\u2010EN","family":"CHIANG","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SHIH\u2010HUANG","family":"LEE","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"KWO\u2010CHANG","family":"UENG","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ZU\u2010CHI","family":"WEN","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YI\u2010JEN","family":"CHEN","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"WEN\u2010CHUNG","family":"YU","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JIN\u2010LONG","family":"HUANG","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CHUEN\u2010WANG","family":"CHIOU","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MAU\u2010SONG","family":"CHANG","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2007,4,20]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.86.4.1233"},{"key":"e_1_2_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(93)91014-9"},{"key":"e_1_2_1_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.90.6.2804"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(94)90007-8"},{"key":"e_1_2_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(95)00029-4"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.92.6.1389"},{"key":"e_1_2_1_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.92.3.430"},{"key":"e_1_2_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(95)00565-X"},{"key":"e_1_2_1_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.92.7.1839"},{"key":"e_1_2_1_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.1986.tb06632.x"},{"key":"e_1_2_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(90)91136-T"},{"key":"e_1_2_1_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.1993.tb01636.x"},{"key":"e_1_2_1_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(94)90757-9"},{"key":"e_1_2_1_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.90.3.1262"},{"key":"e_1_2_1_16_2","first-page":"623","volume-title":"Cardiac Electrophysiology: A Text book","author":"Waldo AL","year":"1990"},{"key":"e_1_2_1_17_2","first-page":"1","article-title":"Characterization and catheter ablation of the antidromic form of typical atrial flutter","volume":"92","author":"Kali JG","year":"1995","journal-title":"Circulation"},{"key":"e_1_2_1_18_2","first-page":"1","article-title":"Electrophysioiogic characteristics of atypical atrial flutter","volume":"92","author":"Kalman JM","year":"1995","journal-title":"Circulation"},{"key":"e_1_2_1_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.92.5.1312"}],"container-title":["Journal of Cardiovascular Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1540-8167.1997.tb00605.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1540-8167.1997.tb00605.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,27]],"date-time":"2023-10-27T11:40:22Z","timestamp":1698406822000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1540-8167.1997.tb00605.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1997,1]]},"references-count":18,"journal-issue":{"issue":"1","published-print":{"date-parts":[[1997,1]]}},"alternative-id":["10.1111\/j.1540-8167.1997.tb00605.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1540-8167.1997.tb00605.x","archive":["Portico"],"relation":{},"ISSN":["1045-3873","1540-8167"],"issn-type":[{"value":"1045-3873","type":"print"},{"value":"1540-8167","type":"electronic"}],"subject":[],"published":{"date-parts":[[1997,1]]}}}