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Right Atrial Collision Time (RACT): A Novel Marker Of Propensity For Typical Atrial Flutter
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  • Damian Redfearn,
  • Nick Ryckman,
  • Derek Crinion,
  • Andres Enriques,
  • David Bakker,
  • Sanoj Chacko,
  • Hoshiar Abdollah,
  • Adrian Baranchuk,
  • Christopher Simpson
Damian Redfearn
Kingston Health Sciences Centre

Corresponding Author:[email protected]

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Nick Ryckman
Kingston Health Sciences Centre
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Derek Crinion
Kingston Health Sciences Centre
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Andres Enriques
Kingston Health Sciences Centre
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David Bakker
Kingston Health Sciences Centre
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Sanoj Chacko
Kingston Health Sciences Centre
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Hoshiar Abdollah
Kingston Health Sciences Centre
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Adrian Baranchuk
Kingston Health Sciences Centre
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Christopher Simpson
Kingston Health Sciences Centre
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Abstract

Introduction: The risk of typical atrial flutter (AFL) is increased proportionately to right atrial (RA) size or right atrial scarring that results in reduced conduction velocity. These characteristics result in propagation of a flutter wave by ensuring the macro re-entrant wave front does not meet its refractory tail. The time taken to traverse the circuit would take account of both of these characteristics and may provide a novel marker of propensity to develop AFL. Our goal was to investigate right atrial collision time (RACT) as a marker of existing or future typical AFL. Methods: This single centre, prospective study recruited consecutive typical AFL ablation patients that were in sinus rhythm. Controls were consecutive electrophysiology study patients >18 years of age. While pacing the coronary sinus (CS) ostium at 600 ms, a local activation time map was created to locate the latest collision point on the anterolateral right atrial wall. This RACT is a measure of conduction velocity and distance from CS to a collision point on the lateral right atrial wall. Results: 98 patients were included in the analysis, 41 with atrial flutter and 57 controls. Patients with atrial flutter were older, 64.7 ± 9.7 vs 52.4 ± 16.8 years (<0.001) and more often male (34/41vs 31/57 (0.003)). The AFL group mean RACT (132.6±17.3 ms) was significantly longer than that of controls (99.1±11.6 ms) (p<0.001). A RACT cut-off of 115.5 ms had a sensitivity and specificity of 92.7% and 93.0% respectively for diagnosis of atrial flutter. An ROC curve indicated an AUC of 0.96 (95% CI: 0.93-1.0, p<0.01). Conclusion: RACT is a novel and promising marker of propensity for typical AFL. This data will inform larger prospective studies. The ability to predict AFL would be of significant clinical value to guide anticoagulation and ablation decisions.
06 Oct 2022Submitted to Journal of Cardiovascular Electrophysiology
06 Oct 2022Submission Checks Completed
06 Oct 2022Assigned to Editor
19 Oct 2022Reviewer(s) Assigned
01 Nov 2022Review(s) Completed, Editorial Evaluation Pending
04 Nov 2022Editorial Decision: Revise Minor
12 Dec 20221st Revision Received
12 Dec 2022Submission Checks Completed
12 Dec 2022Assigned to Editor
12 Dec 2022Review(s) Completed, Editorial Evaluation Pending
12 Dec 2022Reviewer(s) Assigned
09 Jan 2023Editorial Decision: Revise Minor
10 Jan 20232nd Revision Received
10 Jan 2023Assigned to Editor
10 Jan 2023Review(s) Completed, Editorial Evaluation Pending
10 Jan 2023Submission Checks Completed
10 Jan 2023Reviewer(s) Assigned
02 Feb 2023Editorial Decision: Revise Minor
01 Mar 20233rd Revision Received
01 Mar 2023Review(s) Completed, Editorial Evaluation Pending
01 Mar 2023Submission Checks Completed
01 Mar 2023Assigned to Editor
01 Mar 2023Reviewer(s) Assigned
23 Mar 2023Editorial Decision: Revise Minor
24 Mar 20234th Revision Received
29 Mar 2023Submission Checks Completed
29 Mar 2023Assigned to Editor
29 Mar 2023Review(s) Completed, Editorial Evaluation Pending
29 Mar 2023Reviewer(s) Assigned
04 May 2023Editorial Decision: Accept