{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T07:09:05Z","timestamp":1761808145323,"version":"3.37.3"},"reference-count":27,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2017,9,14]],"date-time":"2017-09-14T00:00:00Z","timestamp":1505347200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"National Institute of Health Research Clinical Lectureship award","award":["#2670"],"award-info":[{"award-number":["#2670"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>We hypothesized that very high\u2010density mapping of typical atrial flutter (AFL) would facilitate a more complete understanding of its circuit. Such very high\u2010density mapping was performed with the Rhythmia<jats:sup>TM<\/jats:sup> (Boston Scientific) mapping system using its 64 electrode basket catheter.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>Data were acquired from 13 patients in AFL. Functional anatomy of the right atrium (RA) was readily identified during mapping including the Crista Terminalis and Eustachian ridge. The leading edge of the activation wavefront was identified without interruption and its conduction velocity (CV) was calculated. CV was not different at the cavotricuspid isthmus (CTI) compared to the remainder of the RA (1.02\u00a0vs. 1.03\u00a0m\/s, P\u00a0=\u00a00.93). The sawtooth pattern of the surface electrocardiogram (EKG) flutter waves was compared to the position of the dominant wavefront. The downslope of the surface EKG flutter waves represented on average 73% \u00b1 9% of the total flutter cycle length. During the downslope, the activation wavefront traveled significantly further than during the upslope (182 \u00b1 21\u00a0milliseconds vs. 68 \u00b1 29\u00a0milliseconds, P\u00a0&lt;\u00a00.0001) with no change in CV between the two phases (0.88\u00a0vs. 0.91\u00a0m\/s, P\u00a0=\u00a00.79).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>CV at the CTI is not slower than other RA regions during typical AFL. The gradual downslope of the sawtooth EKG\u00a0\u00a0is not due to slow conduction at the CTI suggesting that success of ablation at this site relates to anatomical properties rather than the presence of a \u201cslow isthmus.\u201d<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.13323","type":"journal-article","created":{"date-parts":[[2017,8,22]],"date-time":"2017-08-22T07:28:36Z","timestamp":1503386916000},"page":"1445-1453","source":"Crossref","is-referenced-by-count":5,"title":["The sawtooth EKG pattern of typical atrial flutter is not related to slow conduction velocity at the cavotricuspid isthmus"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0204-7078","authenticated-orcid":false,"given":"Arunashis","family":"Sau","sequence":"first","affiliation":[{"name":"Imperial Centre for Translational and Experimental Medicine Imperial College London  London UK"},{"name":"Department of Cardiology Imperial College Healthcare NHS Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus B.","family":"Sikkel","sequence":"additional","affiliation":[{"name":"Imperial Centre for Translational and Experimental Medicine Imperial College London  London UK"},{"name":"Department of Cardiology Imperial College Healthcare NHS Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3274-7128","authenticated-orcid":false,"given":"Vishal","family":"Luther","sequence":"additional","affiliation":[{"name":"Imperial Centre for Translational and Experimental Medicine Imperial College London  London UK"},{"name":"Department of Cardiology Imperial College Healthcare NHS Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Wright","sequence":"additional","affiliation":[{"name":"Department of Cardiology Imperial College Healthcare NHS Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando","family":"Guerrero","sequence":"additional","affiliation":[{"name":"Boston Scientific Breakspear Park  Hemel Hempstead Herts UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Koa\u2010Wing","sequence":"additional","affiliation":[{"name":"Department of Cardiology Imperial College Healthcare NHS Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Lefroy","sequence":"additional","affiliation":[{"name":"Department of Cardiology Imperial College Healthcare NHS Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Linton","sequence":"additional","affiliation":[{"name":"Imperial Centre for Translational and Experimental Medicine Imperial College London  London UK"},{"name":"Department of Cardiology Imperial College Healthcare NHS Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norman","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Department of Cardiology Imperial College Healthcare NHS Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zachary","family":"Whinnett","sequence":"additional","affiliation":[{"name":"Imperial Centre for Translational and Experimental Medicine Imperial College London  London UK"},{"name":"Department of Cardiology Imperial College Healthcare NHS Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phang Boon","family":"Lim","sequence":"additional","affiliation":[{"name":"Imperial Centre for Translational and Experimental Medicine Imperial College London  London UK"},{"name":"Department of Cardiology Imperial College Healthcare NHS Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prapa","family":"Kanagaratnam","sequence":"additional","affiliation":[{"name":"Imperial Centre for Translational and Experimental Medicine Imperial College London  London UK"},{"name":"Department of Cardiology Imperial College Healthcare NHS Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas S.","family":"Peters","sequence":"additional","affiliation":[{"name":"Imperial Centre for Translational and Experimental Medicine Imperial College London  London UK"},{"name":"Department of Cardiology Imperial College Healthcare NHS Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. 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