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Background <p>Atypical atrial flutters (AAFLs) comprise a heterogeneous group of reentrant tachycardias usually associated with atrial scarring. The distinctive characteristics of left atrial anterior wall (LAAW)–dependent AAFLs remain unclear.</p> Objective <p>This study aimed to characterize the clinical, anatomical, and electrophysiological features of LAAW-AAFl.</p> Methods <p>We conducted a prospective, multicenter, observational study including consecutive patients undergoing first-time left-sided AAFl ablation. AAFl was classified as “de novo” in the absence of prior LA ablation, cardiac surgery, or congenital heart disease. LAAW-AAFl was diagnosed when the AAFl isthmus was located on the LAAW.</p> Results <p>96 patients were included in the study. Compared to those with other left-sided AAFl, LAAW-AAFl patients were significantly older (<i>p</i> = 0.04), more frequently hypertensive (<i>p</i> = 0.01), diabetic (<i>p</i> = 0.001), with larger LA volume (<i>p</i> = 0.048), and more frequently categorized as having a “de novo” AAFl (<i>p</i> = 0.02). Multi-detector computed tomography (MDCT)-derived analysis showed larger sinus of Valsalva (<i>p</i> = 0.002), non-coronary cusp (<i>p</i> = 0.01), and left-coronary cusp (<i>p</i> = 0.03) diameters in the LAAW-AAFl group, together with a wider aortic root (AR)–LA contact area (<i>p</i> = 0.04) and a narrower AR–LA angle (<i>p</i> = 0.04). In patients with LAAW-AAFL, voltage mapping demonstrated significantly greater scar extension at the LAAW (<i>p</i> &lt; 0.001), with a substantial overlap with the MDCT-derived AR–LA isodistance map (Dice similarity coefficient: 82 ± 8%). In 86.7% of cases the LAAW-AAFl isthmus overlapped with AR–LA contact area at MDCT-derived isodistance maps.</p> Conclusions <p>LAAW-AAFL appears to be a distinct clinical entity, typically affecting older patients with cardiovascular risk factors and often presenting as “de novo”. MDCT-postprocessing demonstrated a larger AR–LA contact area encompassing the AAFL isthmus in most cases, supporting a potential mechanistic role of AR–LA anatomical interaction.</p> Graphical Abstract <p></p>

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Left atrial anterior wall flutter: clinical, anatomical, and electrophysiological characteristics

  • 期刊论文

  • 发表日期：

    2026年3月11日

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  • José Alderete,
  • Giulio Falasconi,
  • David Soto-Iglesias,
  • Alessia Chiara Latini,
  • Federico Landra,
  • Andrea Saglietto,
  • Pietro Francia,
  • Dario Turturiello,
  • Daniel Viveros,
  • Aldo Bellido,
  • Paula Franco-Ocaña,
  • Fatima Zaraket,
  • Marina Huguet,
  • José-Tomas Ortiz-Perez,
  • Oscar Camara,
  • Damián Sánchez-Quintana,
  • Julio Martí-Almor,
  • Diego Penela,
  • Antonio Berruezo

摘要

Background

Atypical atrial flutters (AAFLs) comprise a heterogeneous group of reentrant tachycardias usually associated with atrial scarring. The distinctive characteristics of left atrial anterior wall (LAAW)–dependent AAFLs remain unclear.

Objective

This study aimed to characterize the clinical, anatomical, and electrophysiological features of LAAW-AAFl.

Methods

We conducted a prospective, multicenter, observational study including consecutive patients undergoing first-time left-sided AAFl ablation. AAFl was classified as “de novo” in the absence of prior LA ablation, cardiac surgery, or congenital heart disease. LAAW-AAFl was diagnosed when the AAFl isthmus was located on the LAAW.

Results

96 patients were included in the study. Compared to those with other left-sided AAFl, LAAW-AAFl patients were significantly older (p = 0.04), more frequently hypertensive (p = 0.01), diabetic (p = 0.001), with larger LA volume (p = 0.048), and more frequently categorized as having a “de novo” AAFl (p = 0.02). Multi-detector computed tomography (MDCT)-derived analysis showed larger sinus of Valsalva (p = 0.002), non-coronary cusp (p = 0.01), and left-coronary cusp (p = 0.03) diameters in the LAAW-AAFl group, together with a wider aortic root (AR)–LA contact area (p = 0.04) and a narrower AR–LA angle (p = 0.04). In patients with LAAW-AAFL, voltage mapping demonstrated significantly greater scar extension at the LAAW (p < 0.001), with a substantial overlap with the MDCT-derived AR–LA isodistance map (Dice similarity coefficient: 82 ± 8%). In 86.7% of cases the LAAW-AAFl isthmus overlapped with AR–LA contact area at MDCT-derived isodistance maps.

Conclusions

LAAW-AAFL appears to be a distinct clinical entity, typically affecting older patients with cardiovascular risk factors and often presenting as “de novo”. MDCT-postprocessing demonstrated a larger AR–LA contact area encompassing the AAFL isthmus in most cases, supporting a potential mechanistic role of AR–LA anatomical interaction.

Graphical Abstract