{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T00:45:14Z","timestamp":1775954714495,"version":"3.50.1"},"reference-count":12,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,7,2]],"date-time":"2023-07-02T00:00:00Z","timestamp":1688256000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Although atrial flutter (AFL) is a common arrhythmia that is based on a macro\u2010reentrant tachycardia around the tricuspid annulus, the factors giving rise to typical AFL (t\u2010AFL) versus reverse typical AFL (rt\u2010AFL) are unknown. To investigate the difference between t\u2010AFL and rt\u2010AFL circuits using ultrahigh resolution mapping of the right atrium.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We investigated 30 isthmus\u2010dependent AFL patients (mean age 71, 28 male) who underwent first\u2010time cavo\u2010tricuspid isthmus (CTI) ablation guided by Boston Scientific's Rhythmia mapping system and divided them into two groups: t\u2010AFL (22 patients) and rt\u2010AFL (8 patients). We compared the anatomy and electrophysiology of their reentrant circuits.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Baseline patient characteristics, use of antiarrhythmic drugs, prevalence of atrial fibrillation, AFL cycle length (227.1\u2009\u00b1\u200921.4 vs. 245.5\u2009\u00b1\u200936.0\u2009ms, <jats:italic>p<\/jats:italic>\u2009=\u2009.10), and CTI length (31.9\u2009\u00b1\u20098.3 vs. 31.1\u2009\u00b1\u20095.2\u2009mm, <jats:italic>p<\/jats:italic>\u2009=\u2009.80) did not differ between the two groups. Functional block was observed at the crista terminalis in 16 patients and at the sinus venosus in 11. No functional block was observed in three patients, all of whom belonged to the rt\u2010AFL group. That is, functional block was observed in 100% of the t\u2010AFL group as opposed to 5\/8 (62.5%) of the rt\u2010AFL (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.05). Slow conduction zones were frequently observed at the intra\u2010atrial septum in the t\u2010AFL group and at the CTI in the rt\u2010AFL group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Mapping with ultrahigh\u2010resolution mapping showed differences between t\u2010AFL and rt\u2010AFL in conduction properties in the right atrium and around the tricuspid valve, which suggested directional mechanisms.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.15993","type":"journal-article","created":{"date-parts":[[2023,7,2]],"date-time":"2023-07-02T12:09:20Z","timestamp":1688299760000},"page":"1658-1664","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Differences between typical and reverse typical atrial flutter identified by ultrahigh resolution mapping"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3388-2508","authenticated-orcid":false,"given":"Satoshi","family":"Hara","sequence":"first","affiliation":[{"name":"Cardiovascular Center Tsuchiura Kyodo Hospital  Tsuchiura Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3939-4954","authenticated-orcid":false,"given":"Yoshikazu","family":"Sato","sequence":"additional","affiliation":[{"name":"Cardiovascular Center Tsuchiura Kyodo Hospital  Tsuchiura Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3781-2171","authenticated-orcid":false,"given":"Shigeki","family":"Kusa","sequence":"additional","affiliation":[{"name":"Cardiovascular Center Tsuchiura Kyodo Hospital  Tsuchiura Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoyuki","family":"Miwa","sequence":"additional","affiliation":[{"name":"Cardiovascular Center Tsuchiura Kyodo Hospital  Tsuchiura Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hidenori","family":"Hirano","sequence":"additional","affiliation":[{"name":"Cardiovascular Center Tsuchiura Kyodo Hospital  Tsuchiura Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2116-3127","authenticated-orcid":false,"given":"Tadanori","family":"Nakata","sequence":"additional","affiliation":[{"name":"Cardiovascular Center Tsuchiura Kyodo Hospital  Tsuchiura Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junichi","family":"Doi","sequence":"additional","affiliation":[{"name":"Cardiovascular Center Tsuchiura Kyodo Hospital  Tsuchiura Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2808-1933","authenticated-orcid":false,"given":"Hitoshi","family":"Hachiya","sequence":"additional","affiliation":[{"name":"Cardiovascular Center Tsuchiura Kyodo Hospital  Tsuchiura Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,7,2]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(93)91014-9"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2017.01.019"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2019.04.029"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.99.21.2771"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.1998.tb00913.x"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(96)00480-9"},{"key":"e_1_2_8_8_1","doi-asserted-by":"crossref","unstructured":"MilliezP RichardsonAW Obioha\u2010NgwuO ZimetbaumPJ PapageorgiouP JosephsonMEVariable Electrocardiographic Characteristics of Isthmus\u2010Dependent Atrial 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