Atrial Flutter - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

ATRIAL FLUTTER A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AME...

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ATRIAL FLUTTER A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Atrial Flutter: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00110-1 1. Atrial Flutter-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on atrial flutter. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON ATRIAL FLUTTER....................................................................................... 3 Overview........................................................................................................................................ 3 Federally Funded Research on Atrial Flutter................................................................................. 3 The National Library of Medicine: PubMed .................................................................................. 6 CHAPTER 2. NUTRITION AND ATRIAL FLUTTER ............................................................................. 53 Overview...................................................................................................................................... 53 Finding Nutrition Studies on Atrial Flutter ............................................................................... 53 Federal Resources on Nutrition ................................................................................................... 54 Additional Web Resources ........................................................................................................... 55 CHAPTER 3. ALTERNATIVE MEDICINE AND ATRIAL FLUTTER ...................................................... 57 Overview...................................................................................................................................... 57 National Center for Complementary and Alternative Medicine.................................................. 57 Additional Web Resources ........................................................................................................... 60 General References ....................................................................................................................... 60 CHAPTER 4. PATENTS ON ATRIAL FLUTTER ................................................................................... 61 Overview...................................................................................................................................... 61 Patents on Atrial Flutter ............................................................................................................. 61 Patent Applications on Atrial Flutter.......................................................................................... 73 Keeping Current .......................................................................................................................... 80 CHAPTER 5. PERIODICALS AND NEWS ON ATRIAL FLUTTER ......................................................... 81 Overview...................................................................................................................................... 81 News Services and Press Releases................................................................................................ 81 Academic Periodicals covering Atrial Flutter.............................................................................. 83 CHAPTER 6. RESEARCHING MEDICATIONS .................................................................................... 85 Overview...................................................................................................................................... 85 U.S. Pharmacopeia....................................................................................................................... 85 Commercial Databases ................................................................................................................. 86 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 89 Overview...................................................................................................................................... 89 NIH Guidelines............................................................................................................................ 89 NIH Databases............................................................................................................................. 91 Other Commercial Databases....................................................................................................... 93 APPENDIX B. PATIENT RESOURCES ................................................................................................. 95 Overview...................................................................................................................................... 95 Patient Guideline Sources............................................................................................................ 95 Finding Associations.................................................................................................................... 97 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 99 Overview...................................................................................................................................... 99 Preparation................................................................................................................................... 99 Finding a Local Medical Library.................................................................................................. 99 Medical Libraries in the U.S. and Canada ................................................................................... 99 ONLINE GLOSSARIES................................................................................................................ 105 Online Dictionary Directories ................................................................................................... 105 ATRIAL FLUTTER DICTIONARY ............................................................................................ 107 INDEX .............................................................................................................................................. 131

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with atrial flutter is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about atrial flutter, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to atrial flutter, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on atrial flutter. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to atrial flutter, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on atrial flutter. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON ATRIAL FLUTTER Overview In this chapter, we will show you how to locate peer-reviewed references and studies on atrial flutter.

Federally Funded Research on Atrial Flutter The U.S. Government supports a variety of research studies relating to atrial flutter. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to atrial flutter. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore atrial flutter. The following is typical of the type of information found when searching the CRISP database for atrial flutter: •

Project Title: ATRIONODAL BUNDLES: HISTOLOGIC AND PHYSIOLOGIC VALIDATION Principal Investigator & Institution: Racker, Darlene Katie; Medicine; Northwestern University Office of Sponsored Research Chicago, Il 60611 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2006

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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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Summary: (provided by applicant): Radiofrequency (RF) catheter ablation of either the "slow" or "fast" AV nodal pathways can cure AV node reentrant tachycardia (AVNRT) and also modify ventricular response to atrial flutter and fibrillation. However, neither the tissues nor mechanisms underlying these arrhythmias are known. Recently, we demonstrated that two separate atrial circuits overlap in the AV junction region: components of the "muscular valvular apparatus", the "circumferential and the perpendicular laminae," which also form the inferior medial atrial wall; and, the collagen encased "multilimb input" to the AVN: the "atrionodal bundles (ABs) and the proximal AV bundle (PAVB)," which is outside of the medial atrial wall epicardium. We showed that each tissue possess unique extracellular (EAP) and transmembrane action potentials (TAP) and transmission properties; EAPs from the atrial and specialized tissues appear side-by-side in traces made at sites where the atrial and specialized tissues overlap; and atrial EAPs and contractions ceased with exposure to high potassium. HYPOTHESIS: A specialized multilimb AVN input with unique histologic and conduction properties is present in human and dog heart. SPECIFIC AIMS are to determine: 1) the position of the ABs and the PAVB in human heart; 2) the myocyte evoking the AB potential and its electrical pathway after iontophoresis of Lucifer Yellow (LY); 3) transmission properties of the ABs during program stimulation of the ABs and SAN by evalulation of the SAN-AB intervals; 4) each ABs role in AVN activation by alterations in the SAN-AVN interval due either to selective ablation of LY-fiUed myofibers or to transection of the AB/PAVB junctions. METHODS: Electrical potentials will be recorded using simultaneous (a) stationary catheter electrodes at the SAN, 3ABs, PAVB, and AVN to monitor electrical coupling, (b) wire electrodes to localize injection and recording sites, responses to photoablation, (c) multielctrode array plaque, (d) 1 percent LY or 3M KCI miropipet electrodes for recording and dye injection using current pulses. Ablations will be made using blue light and scalpel blades. The anatomy, LY pathways, and effects of photoloysis will be evaluated by 3D analysis and reconstructions. Alterations in morphology of electrical potentials, and conduction intervals will be confirmed via timing in the SAN trace and correlation of EAPs and TAPs. These studies are expected to provide a basis for evaluating transmission, arrhythmogenesis, and drug interactions at the tissue level. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: POST CORONARY BYPASS ATRIAL ARRHYTHMIC PREDICTION RULE Principal Investigator & Institution: Passman, Rod S.; Assistant Professor of Medicine and Prev; Medicine; Northwestern University Office of Sponsored Research Chicago, Il 60611 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): The proposed study seeks to develop and validate a clinical prediction rule for post-coronary artery bypass grafting (CABG) atrial fibrillation and atrial flutter (AF). These arrhythmias occur in 20-40% of the 500,000 patients undergoing CABG, and increase the morbidity, cost, and length of stay associated with the procedure. Though several studies have suggested that prophylactic therapy with beta-adrenergic blockers decreases the risk of post-CABG AF, this efficacy has not been universally appreciated. As a result, several new prophylactic therapies have been introduced, though some with significant toxicities associated with them. It is therefore imperative to identify a priori those individuals most at risk of developing post-CABG AF, as well as those unlikely to develop this endpoint. In this manner, those individuals most at risk of developing post-CABG AF may be targeted for prophylactic

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therapy, while those in a low risk category may be spared the exposure to a potentially deleterious therapy from which they are less likely to derive benefit. Additionally, the identification of a high-risk subgroup would allow for the execution of smaller randomized controlled trials, and may provide insight into the etiology of post-CABG AF. The study is a retrospective cohort study designed to identify pre-, intra-, and postoperative variables which may be associated with post-CABG AF. From these results, a clinical prediction rule will be formulated. Validation of the prediction rule will then take place in a prospective cohort study using a different group of patients from which the rule was derived. This will allow for the assessment of both validity and generalizability. The candidate has committed himself to a career as an independent investigator, with an interest in the application of rigorous epidemiologic techniques to questions of importance in cardiac electrophysiology, his area of clinical expertise. This project will be an integral part of the candidate?s career development plan and his maturation as an epidemiologist, cardiac electrophysiologist, and clinical investigator. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SURGICAL TREATMENT OF CARDIAC ARRHYTHMIAS Principal Investigator & Institution: Boineau, John P.; Medical Science Service; Surgery; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 08-AUG-1983; Project End 31-JUL-2003 Summary: This renewal application requests five years' support for work now in continuous progress for over 15 years at Washington University. Dr. John Boineau, the new PI, has replaced Dr. James Cox, the former P1, who transferred to Georgetown University Hospital. Dr. Cox remains as a special consultant. The broad aims continue to be the direct or surgical ablation of cardiac arrhythmias. The emphasis of the current renewal is focused upon the development of a new procedure, the radial incisions approach (RIA), to eradicate atrial fibrillation (AF) and restore atrial transport function and is directed primarily toward patients undergoing surgery for valvular or ischemic heart disease. Conventional valve or CABG surgery does not eliminate and may not prevent AF in these patients. The availability of an effective means of eradicating this arrhythmia in these patients at the time of surgery would permit control of rate and rhythm, limit embolic stroke, and improve cardiac performance, outcome, and the quality of life. Whereas the Maze and RIA assume randomly distributed and changing reentry which are eliminated without prior activation mapping, new data indicate that some forms of AF result from (spatially) stable reentry which can be identified by new mapping methods and focally ablated. Thus, a second project is directed toward map guided, focal cryoablation of AF. This could be performed off bypass as a more limited and rapid alternative to the more extensive and (bypass) time consuming RIA procedure. A third project is targeted at prevention and correction of postoperative atrial flutter (AFL) after the Fontan operation in congenital heart patients or after lung transplant surgery. Studies will be performed in both realistic animal models with atrial enlargement and patients with AF and AFL and will center about the use of new automated, 3-D mapping techniques and rapid numerical analysis of potentials recorded simultaneously from to 512 electrodes during the arrhythmias. Preliminary observations indicate that the proposed studies are feasible, will provide new information regarding the different mechanisms of AF and AFL that are related to atrial enlargement and/or atrial surgery, and this data will be used to develop the new surgical ablation techniques to control or prevent these arrhythmias. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with atrial flutter, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “atrial flutter” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for atrial flutter (hyperlinks lead to article summaries): •

A case of atrial flutter or fibrillation? Author(s): Liu CC, Hsieh MH, Tai CT, Chen SA. Source: Pacing and Clinical Electrophysiology : Pace. 1999 December; 22(12): 1825-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10642140

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Ablation of atypical atrial flutter guided by the use of concealed entrainment in patients without prior cardiac surgery. Author(s): Bogun F, Bender B, Li YG, Hohnloser SH. Source: Journal of Cardiovascular Electrophysiology. 2000 February; 11(2): 136-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10709707

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Ablation of typical atrial flutter using a three-dimensional ultrasound mapping system. Author(s): Spitzer SG, Karolyi L, Rammler C, Otto T, Jung F. Source: Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing. 2003 June; 8(3): 181-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12815303

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Acute and long-term results of radiofrequency ablation of common atrial flutter and the influence of the right atrial isthmus ablation on the occurrence of atrial fibrillation. Author(s): Schmieder S, Ndrepepa G, Dong J, Zrenner B, Schreieck J, Schneider MA, Karch MR, Schmitt C. Source: European Heart Journal. 2003 May; 24(10): 956-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12714027

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PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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Acute coronary occlusion during radiofrequency catheter ablation of typical atrial flutter. Author(s): Ouali S, Anselme F, Savoure A, Cribier A. Source: Journal of Cardiovascular Electrophysiology. 2002 October; 13(10): 1047-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12435195

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Acute results of transvenous cryoablation of supraventricular tachycardia (atrial fibrillation, atrial flutter, Wolff-Parkinson-White syndrome, atrioventricular nodal reentry tachycardia). Author(s): Rodriguez LM, Geller JC, Tse HF, Timmermans C, Reek S, Lee KL, Ayers GM, Lau CP, Klein HU, Crijns HJ. Source: Journal of Cardiovascular Electrophysiology. 2002 November; 13(11): 1082-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12475096

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Alternans of atrial action potentials during atrial flutter as a precursor to atrial fibrillation. Author(s): Narayan SM, Bode F, Karasik PL, Franz MR. Source: Circulation. 2002 October 8; 106(15): 1968-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12370221

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An atypical atrial flutter of focal origin: a study using a noncontact mapping system. Author(s): Ouali S, Anselme F, Savoure A, Cribier A. Source: Pacing and Clinical Electrophysiology : Pace. 2003 June; 26(6): 1410-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12822758

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Apical hypertrophic cardiomyopathy associated with life-threatening paroxysmal atrial flutter with a slow ventricular response: a case report. Author(s): Hiasa G, Hamada M, Kodama K, Watanabe S, Ohtsuka T, Ikeda S, Hashida H, Kuwahara T, Hara Y, Shigematsu Y, Hiwada K. Source: Japanese Circulation Journal. 2000 March; 64(3): 225-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10732858

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Atrial electrogram amplitude and efficacy of cavotricuspid isthmus ablation for atrial flutter. Author(s): Ozaydin M, Tada H, Chugh A, Scharf C, Lai SW, Pelosi F Jr, Knight BP, Morady F, Oral H. Source: Pacing and Clinical Electrophysiology : Pace. 2003 September; 26(9): 1859-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12930501

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Atrial flutter after coronary artery bypass grafting: proposed mechanism as illuminated by independent predictors. Author(s): Mori S S, Fujii G G, Ishida H H, Tomari S S, Matsuura A A, Yoshida K K. Source: Ann Thorac Cardiovasc Surg. 2003 February; 9(1): 50-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12667130

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Atrial flutter following a wasp sting. Author(s): Fisher BA, Antonios TF. Source: Journal of Postgraduate Medicine. 2003 July-September; 49(3): 254-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14597791

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Atrial flutter in the perinatal age group: diagnosis, management and outcome. Author(s): Lisowski LA, Verheijen PM, Benatar AA, Soyeur DJ, Stoutenbeek P, Brenner JI, Kleinman CS, Meijboom EJ. Source: Journal of the American College of Cardiology. 2000 March 1; 35(3): 771-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10716482

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Atrial flutter update. Author(s): Cosio FG. Source: Cardiac Electrophysiology Review. 2002 December; 6(4): 356-64. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12438813

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Atrial flutter vector loops derived from the surface ECG: does the plane of the loop correspond anatomically to the macroreentrant circuit? Author(s): Ng J, Sahakian AV, Fisher WG, Swiryn S. Source: Journal of Electrocardiology. 2003; 36 Suppl: 181-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14716630

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Atrial flutter with 1:1 conduction. Author(s): Tan JL, Teo WS. Source: Heart (British Cardiac Society). 2002 October; 88(4): 414. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12231606

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Atrial flutter: arrhythmia circuit and basis for radiofrequency catheter ablation. Author(s): Foldesi C, Pandozi C, Peichl P, Bulava A, Castro A, Lamberti F, Calo L, Loricchio ML, Santini M. Source: Ital Heart J. 2003 June; 4(6): 395-403. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12898804

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Atrial tachycardia with recipient-to-donor atrioatrial conduction and isthmusdependent donor atrial flutter in a patient after orthotopic heart transplantation. Successful treatment by radiofrequency catheter ablation. Author(s): Fournet D, Zimmermann M, Campanini C. Source: The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation. 2002 August; 21(8): 923-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12163096

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Atypical atrial flutter originating in the right atrial free wall. Author(s): Kall JG, Rubenstein DS, Kopp DE, Burke MC, Verdino RJ, Lin AC, Johnson CT, Cooke PA, Wang ZG, Fumo M, Wilber DJ. Source: Circulation. 2000 January 25; 101(3): 270-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10645923

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Basket catheter localization of the origin of atrial tachycardia with atypical morphology after atrial flutter ablation. Author(s): Rodriguez E, Callans D, Kantharia B, Gottlieb C, Marchlinski FE. Source: Pacing and Clinical Electrophysiology : Pace. 2000 February; 23(2): 269-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10709237

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Basket catheter-guided three-dimensional activation patterns construction and ablation of common type atrial flutter. Author(s): Zrenner B, Ndrepepa G, Schneider M, Karch M, Deisenhofer I, Schreieck J, Schomig A, Schmitt C. Source: Pacing and Clinical Electrophysiology : Pace. 2000 September; 23(9): 1350-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11025890

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Biatrial activation in isthmus-dependent atrial flutter. Author(s): Rodriguez LM, Timmermans C, Nabar A, Hofstra L, Wellens HJ. Source: Circulation. 2001 November 20; 104(21): 2545-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11714648

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Bi-morphic atrial flutter. Author(s): Wang T, Danoviz J. Source: Journal of Electrocardiology. 1977 April; 10(2): 189-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=858978

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Block of the lower interatrial connections: insight into the sources of electrocardiographic diversities in common type atrial flutter. Author(s): Zrenner B, Ndrepepa G, Karch M, Schneider M, Schmitt C. Source: Pacing and Clinical Electrophysiology : Pace. 2000 May; 23(5): 917-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10833717

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Atrial Flutter

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Body surface mapping of counterclockwise and clockwise typical atrial flutter: a comparative analysis with endocardial activation sequence mapping. Author(s): SippensGroenewegen A, Lesh MD, Roithinger FX, Ellis WS, Steiner PR, Saxon LA, Lee RJ, Scheinman MM. Source: Journal of the American College of Cardiology. 2000 April; 35(5): 1276-87. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10758970

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Body surface maps in 2 cases of atrial flutter. Author(s): Kawano S, Sawanobori T, Hiraoka M. Source: Japanese Heart Journal. 1984 March; 25(2): 283-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6748227

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Case report: severe skin burn at the site of the indifferent electrode after radiofrequency catheter ablation of typical atrial flutter. Author(s): Goette A, Reek S, Klein HU, Geller JC. Source: Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing. 2001 September; 5(3): 337-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11500589

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Catheter ablation for atrial fibrillation and atrial flutter: from D.C. shocks to radiofrequency current. Author(s): Luderitz B. Source: Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing. 2000 June; 4(2): 441. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11202987

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Catheter ablation of atrial flutter and macroreentrant atrial tachycardia. Author(s): Wu RC, Berger R, Calkins H. Source: Current Opinion in Cardiology. 2002 January; 17(1): 58-64. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11790935

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Catheter ablation of atrial flutter guided by electroanatomic mapping (CARTO): a randomized comparison to the conventional approach. Author(s): Willems S, Weiss C, Ventura R, Ruppel R, Risius T, Hoffmann M, Meinertz T. Source: Journal of Cardiovascular Electrophysiology. 2000 November; 11(11): 1223-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11083243

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Catheter ablation of atrial flutter in a heart transplant recipient. Author(s): Krishnan SC, Falsone JM, Sanders WE, Chen H, Mill MR, Kushwaha SS. Source: Pacing and Clinical Electrophysiology : Pace. 2002 August; 25(8): 1262-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12358178

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Catheter ablation of inducible atrial flutter, in combination with atrial pacing and antiarrhythmic drugs ("hybrid therapy") improves rhythm control in patients with refractory atrial fibrillation. Author(s): Prakash A, Saksena S, Krol RB, Filipecki A, Philip G. Source: Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing. 2002 June; 6(2): 165-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11992027

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Characterization of the anatomy and conduction velocities of the human right atrial flutter circuit determined by noncontact mapping. Author(s): Schilling RJ, Peters NS, Goldberger J, Kadish AH, Davies DW. Source: Journal of the American College of Cardiology. 2001 August; 38(2): 385-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11499728

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Classification of atrial flutter and regular atrial tachycardia according to electrophysiologic mechanism and anatomic bases: a statement from a joint expert group from the Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Author(s): Saoudi N, Cosio F, Waldo A, Chen SA, Iesaka Y, Lesh M, Saksena S, Salerno J, Schoels W. Source: Journal of Cardiovascular Electrophysiology. 2001 July; 12(7): 852-66. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11469446

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Clinical course after radiofrequency ablation of type I atrial flutter. Identification of patients who risk atrial arrhythmia recurrences. Author(s): Brembilla-Perrot B. Source: European Heart Journal. 2002 March; 23(6): 441-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11863346

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Clinical implication of the double potentials at the cavotricuspid isthmus for radiofrequency catheter ablation of typical atrial flutter. Author(s): Sasano T, Okishige K. Source: Journal of Electrocardiology. 2002 October; 35(4): 321-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12395359

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Clinical significance of residual slow cavotricuspid isthmus conduction after ablation of typical atrial flutter. Author(s): Takahashi R, Iesaka Y, Takahashi A, Hiroe M, Marumo F. Source: Pacing and Clinical Electrophysiology : Pace. 2000 November; 23(11 Pt 2): 19027. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11139954

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Atrial Flutter

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Coexistence of type I atrial flutter and intra-atrial re-entrant tachycardia in patients with surgically corrected congenital heart disease. Author(s): Akar JG, Kok LC, Haines DE, DiMarco JP, Mounsey JP. Source: Journal of the American College of Cardiology. 2001 August; 38(2): 377-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11499727

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Combined right atrial resection for lung cancer that developed intractable atrial flutter. Author(s): Ohta M, Hazama K, Kagisaki K, Matsumiya G, Nakayama H, Matsuda H. Source: Jpn J Thorac Cardiovasc Surg. 2003 March; 51(3): 117-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12691123

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Common atrial flutter sustained by a right atrial circus movement with anticlockwise rotation: the first demonstration in humans. Author(s): Saoudi N, Yaici K, Rinaldi JP, Ricard P, Bergonzi M, Barold SS. Source: Pacing and Clinical Electrophysiology : Pace. 2002 April; 25(4 Pt 1): 481-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11991374

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Comparison of results of an 8-mm split-tip versus a 4-mm tip ablation catheter to perform radiofrequency ablation of type I atrial flutter. Author(s): Rodriguez LM, Nabar A, Timmermans C, Wellens HJ. Source: The American Journal of Cardiology. 2000 January 1; 85(1): 109-12, A9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11078249

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Complete atrioventricular block associated with atrial flutter in fetus with positive maternal anti-SSA antibody. Author(s): Nakamura S, Maeno Y, Matsuishi T. Source: Pediatric Cardiology. 2003 March-April; 24(2): 182-3. Epub 2003 February 10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12574974

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Conduction properties of the crista terminalis and its influence on the right atrial activation sequence in patients with typical atrial flutter. Author(s): Yamabe H, Misumi I, Fukushima H, Ueno K, Kimura Y, Hokamura Y. Source: Pacing and Clinical Electrophysiology : Pace. 2002 February; 25(2): 132-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11915978

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Conduction velocity around the tricuspid valve annulus during type 1 atrial flutter: defining the location of areas of slow conduction by three-dimensional electroanatomical mapping. Author(s): Hassankhani A, Yao B, Feld GK. Source: Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing. 2003 April; 8(2): 121-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12766503

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Contemporary management of atrial flutter. Author(s): Wellens HJ. Source: Circulation. 2002 August 6; 106(6): 649-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12163422

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Correlation between electrogram morphology and standard criteria to validate bidirectional cavotricuspid block in common atrial flutter ablation. Author(s): Andronache M, de Chillou C, Miljoen H, Magnin-Poull I, Messier M, Dotto P, Beurrier D, Doan T, Houriez P, Bineau-Jorisse A, Thiel B, Brembilla-Perrot B, Massing JL, Sadoul N, Aliot E. Source: Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2003 October; 5(4): 335-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14753627

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Dangerous consequence from use of phenytoin in atrial flutter. Author(s): Grissom JH, Sy BG, Duffy JP, Dunea G. Source: British Medical Journal. 1967 October 7; 4(570): 34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6047829

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Delayed restoration of atrial function after conversion of atrial flutter by pacing or electrical cardioversion. Author(s): Jordaens L, Missault L, Germonpre E, Callens B, Adang L, Vandenbogaerde J, Clement DL. Source: The American Journal of Cardiology. 1993 January 1; 71(1): 63-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8420237

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Demonstration of an area of slow conduction in human atrial flutter. Author(s): Olshansky B, Okumura K, Hess PG, Waldo AL. Source: Journal of the American College of Cardiology. 1990 December; 16(7): 1639-48. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2254549

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Demonstration of macroreentry and feasibility of operative therapy in the common type of atrial flutter. Author(s): Klein GJ, Guiraudon GM, Sharma AD, Milstein S. Source: The American Journal of Cardiology. 1986 March 1; 57(8): 587-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3953444

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Atrial Flutter

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Diagnosis and ablation of atrial flutter using a high resolution, noncontact mapping system. Author(s): Schmitt H, Weber S, Tillmanns H, Waldecker B. Source: Pacing and Clinical Electrophysiology : Pace. 2000 December; 23(12): 2057-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11202247

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Diameters of the cavo-sinus-tricuspid area in relation to type I atrial flutter. Author(s): Kozlowski D, Hreczecha J, Skwarek M, Piwko G, Kosinski A, Gawrysiak M, Grzybiak M. Source: Folia Morphol (Warsz). 2003 May; 62(2): 133-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12866674

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Diastolic mitral regurgitation with atrial flutter. Author(s): Malcolm I. Source: American Heart Journal. 1996 December; 132(6): 1321-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8969608

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Different patterns of interatrial conduction in clockwise and counterclockwise atrial flutter. Author(s): Marine JE, Korley VJ, Obioha-Ngwu O, Chen J, Zimetbaum P, Papageorgiou P, Milliez P, Josephson ME. Source: Circulation. 2001 September 4; 104(10): 1153-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11535572

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Differentiation of atrial flutter from atrial fibrillation. Author(s): Rautaharju PM. Source: Journal of Electrocardiology. 2000 April; 33(2): 203. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10819415

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Direct catheter fulguration of atrial flutter. Author(s): Saoudi N, Mouton-Schleiffer D, Letac B. Source: Lancet. 1987 September 5; 2(8558): 568-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2887858

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Direct conversion of atrial flutter to sinus rhythm with low-output, short-duration transesophageal atrial pacing. Author(s): Ajisaka H, Hiraki T, Ikeda H, Kubara I, Yoshida T, Ohga M, Imaizumi T. Source: Clin Cardiol. 1997 September; 20(9): 762-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9294667

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Direct-current cardioversion for the conversion of atrial flutter. Author(s): Chalasani P, Cambre S, Silverman ME. Source: The American Journal of Cardiology. 1996 March 15; 77(8): 658-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8610624

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Discrimination of sinus rhythm, atrial flutter, and atrial fibrillation using bipolar endocardial signals. Author(s): Jung J, Hohenberg G, Heisel A, Strauss D, Schieffer H, Fries R. Source: Journal of Cardiovascular Electrophysiology. 1998 July; 9(7): 689-95. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9684716

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Disturbed atrioventricular electromechanical function long after Mustard operation for transposition of great arteries: a potential contributing factor to atrial flutter. Author(s): Li W, Somerville J, Gibson DG, Henein MY. Source: Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography. 2001 November; 14(11): 1088-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11696833

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Does complexity theory apply to the conduction ratios occurring during progression of stable atrial flutter with 2:1 into 4:1 atrioventricular block? Author(s): Castellanos A, Moleiro F, Saoudi N, de la Hera A, Myerburg RJ. Source: The American Journal of Cardiology. 1995 May 1; 75(14): 947-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7733010

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Dofetilide versus quinidine for atrial flutter: viva la difference!? Author(s): Olshansky B. Source: Journal of Cardiovascular Electrophysiology. 1996 September; 7(9): 828-32. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8884511

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Dofetilide: a review of its use in atrial fibrillation and atrial flutter. Author(s): McClellan KJ, Markham A. Source: Drugs. 1999 December; 58(6): 1043-59. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10651390

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Double potential interval and transisthmus conduction time for prediction of cavotricuspid isthmus block after ablation of typical atrial flutter. Author(s): Tai CT, Haque A, Lin YK, Tsao HM, Ding YA, Chang MS, Chen SA. Source: Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing. 2002 August; 7(1): 77-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12391423

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Atrial Flutter

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Double potentials along the ablation line as a guide to radiofrequency ablation of typical atrial flutter. Author(s): Tada H, Oral H, Sticherling C, Chough SP, Baker RL, Wasmer K, Pelosi F Jr, Knight BP, Strickberger SA, Morady F. Source: Journal of the American College of Cardiology. 2001 September; 38(3): 750-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11527628

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Double potentials analysis as a guide to radiofrequency ablation of atrial flutter. Author(s): Turco P, Stabile G, De Simone A, El Jamal B. Source: Journal of the American College of Cardiology. 2002 March 6; 39(5): 916-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11869864

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Early recurrence of arrhythmia in patients taking amiodarone or class 1C agents for treatment of atrial fibrillation or atrial flutter. Author(s): Hauser TH, Pinto DS, Josephson ME, Zimetbaum P. Source: The American Journal of Cardiology. 2004 May 1; 93(9): 1173-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15110217

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Early versus late atrial fibrillation after atrial flutter ablation. Author(s): Loutrianakis E, Barakat T, Olshansky B. Source: Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing. 2002 June; 6(2): 173-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11992028

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ECG of the month. Common denominator. Atrial flutter. Author(s): Martinez-Lopez JI. Source: J La State Med Soc. 2002 March-April; 154(2): 51-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12014452

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ECG of the month. Orderly misconduct. Atrial flutter. Author(s): Martinez-Lopez JI. Source: J La State Med Soc. 1999 December; 151(12): 593-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10643197

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ECG of the month. Sinister implications? Atrial flutter. Author(s): Martinez-Lopez JI. Source: J La State Med Soc. 2001 July; 153(7): 337-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11519214

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Effect of atrial flutter on exercise tolerance in patients with grown-up congenital heart (GUCH). Author(s): Li W, Somerville J, Gibson DG, Henein MY. Source: American Heart Journal. 2002 July; 144(1): 173-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12094205

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Effectiveness of irrigated tip catheter ablation of common atrial flutter. Author(s): Jais P, Hocini M, Gillet T, Shah DC, Haissaguerre M, Yamane T, Deisenhofer I, Garrigue S, Le Metayer P, Roudaut R, Clementy J. Source: The American Journal of Cardiology. 2001 August 15; 88(4): 433-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11545772

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Effects of cavotricuspid isthmus ablation on atrioventricular node electrophysiology in patients with typical atrial flutter. Author(s): Tai CT, Tsai CF, Hsieh MH, Lin WS, Lin YK, Lee SH, Yu WC, Ding YA, Chang MS, Chen SA. Source: Circulation. 2001 September 25; 104(13): 1501-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11571243

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Effects of linear ablation at the isthmus between the tricuspid annulus and inferior vena cava for atrial flutter on autonomic nervous activity: analysis of heart rate variability. Author(s): Li A, Kuga K, Suzuki A, Endo M, Niho B, Enomoto M, Kanemoto M, Yamaguchi I. Source: Circulation Journal : Official Journal of the Japanese Circulation Society. 2002 January; 66(1): 53-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11999666

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Efficacy of biphasic waveform cardioversion for atrial fibrillation and atrial flutter compared with conventional monophasic waveforms. Author(s): Ermis C, Zhu AX, Sinha S, Iskos D, Sakaguchi S, Lurie KG, Benditt DG. Source: The American Journal of Cardiology. 2002 October 15; 90(8): 891-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12372583

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Electric cardioversion of atrial flutter in a critically ill patient in the prone position. Author(s): Fikkers BG, Bello CR, van Dijk AP. Source: Intensive Care Medicine. 2001 February; 27(2): 449. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11396298

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Atrial Flutter

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Electrocardiographic and electrophysiological characteristics of atrial fibrillation organized into atrial flutter by oral administration of class I antiarrhythmic agents. Author(s): Ohmura K, Kobayashi Y, Miyauchi Y, Endoh Y, Atarashi H, Katoh T, Takano T. Source: Pacing and Clinical Electrophysiology : Pace. 2003 March; 26(3): 692-702. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12698669

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Electrocardiology teacher analysis and review: slow atrial flutter with the rare conduction ratio. Author(s): Spodick DH. Source: The American Journal of Geriatric Cardiology. 2003 November-December; 12(6): 372. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14610389

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Electrophysiologic characteristics and ablation of an atypical atrial flutter in the right atrium. Author(s): Chang KC, Lin YC, Chou HT, Hung JS. Source: Journal of Cardiovascular Electrophysiology. 2000 March; 11(3): 334-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10749358

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Electrophysiological evaluation and ablation of atypical right atrial flutter. Author(s): Shah D, Jais P, Haissaguerre M. Source: Cardiac Electrophysiology Review. 2002 December; 6(4): 365-70. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12438814

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Electrophysiological response of the right atrium to ibutilide during typical atrial flutter. Author(s): Cheng J, Glatter K, Yang Y, Zhang S, Lee R, Scheinman MM. Source: Circulation. 2002 August 13; 106(7): 814-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12176953

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Electrophysiology of inducible atrial flutter in patients with atrioventricular nodal reentrant tachycardia. Author(s): Liu S, Yuan S, Hertervig E, Kongstad O, Ljungstrom E, Bertil Olsson S. Source: Clinical Physiology and Functional Imaging. 2004 January; 24(1): 19-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14717744

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Enlarged effects of adenosine in a septic patient with multiple myeloma and atrial flutter. Author(s): Dierkes S, Hennersdorf MG, Perings C, Strauer BE. Source: Acta Cardiol. 2003 August; 58(4): 363-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12948044

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Evaluation of transisthmus conduction interval in predicting bidirectional block after ablation of typical atrial flutter. Author(s): Ren X, Lu S, Guo C, Chen L, Liu H, Tian R, Yang Y, Zhang J. Source: Chinese Medical Journal. 2003 November; 116(11): 1770-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14642157

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Excitable gap composition in the presence of antiarrhythmic drugs in common human atrial flutter. Author(s): Jalil E, Mensour B, Vinet A, Kus T. Source: The Canadian Journal of Cardiology. 2003 March 15; 19(3): 244-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12677279

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F vector loop in atrial flutter. Author(s): Sano T, Hiroki T, Hazama H, Hentona T. Source: Bull Tokyo Med Dent Univ. 1968 March; 15(1): 59-66. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5244545

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Facilitating influence of disopyramide on atrial flutter termination by overdrive pacing. Author(s): Della Bella P, Tondo C, Marenzi G, Cipolla CM, Doni F, Grazi S, Rimondini A, Salvioni A, Guazzi MD. Source: The American Journal of Cardiology. 1988 May 1; 61(13): 1046-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3284318

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Facilitating influence of procainamide on conversion of atrial flutter by rapid atrial pacing. Author(s): Heisel A, Jung J, Stopp M, Schieffer H. Source: European Heart Journal. 1997 May; 18(5): 866-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9152658

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Factors associated with early atrial fibrillation after ablation of common atrial flutter. A single centre prospective study. Author(s): Da Costa A, Romeyer C, Mourot S, Messier M, Cerisier A, Faure E, Isaaz K. Source: European Heart Journal. 2002 March; 23(6): 498-506. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11863353

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Factors that influence the development of atrial flutter after the Fontan operation. Author(s): Fishberger SB, Wernovsky G, Gentles TL, Gauvreau K, Burnett J, Mayer JE Jr, Walsh EP. Source: The Journal of Thoracic and Cardiovascular Surgery. 1997 January; 113(1): 80-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9011705

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Atrial Flutter

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Failure of atrial flutter detection by a pacemaker with a dedicated atrial flutter detection algorithm. Author(s): Israel CW, Barold SS. Source: Pacing and Clinical Electrophysiology : Pace. 2002 August; 25(8): 1274-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12358181

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False positive signal-averaged electrocardiogram produced by atrial flutter. Author(s): Schrem SS, Nachamie M, Weiss E. Source: American Heart Journal. 1990 September; 120(3): 698-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2389709

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Familial atrial standstill with coexistent atrial flutter. Author(s): Balaji S, Till J, Shinebourne EA. Source: Pacing and Clinical Electrophysiology : Pace. 1998 September; 21(9): 1841-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9744455

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Fetal atrial flutter and fibrillation: prenatal echocardiographic detection and management. Author(s): Chao RC, Ho ES, Hsieh KS. Source: American Heart Journal. 1992 October; 124(4): 1095-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1529890

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Fetal atrial flutter and necrotizing enterocolitis in a term neonate. Author(s): Petrikovsky BM, Biancaniello TM, Shmoys SM. Source: Pediatric Cardiology. 1991 April; 12(2): 131. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1866336

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Fetal atrial flutter and X-linked dominant vitamin D-resistant rickets. Author(s): Vintzileos AM, Campbell WA, Soberman SM, Nochimson DJ. Source: Obstetrics and Gynecology. 1985 March; 65(3 Suppl): 39S-44S. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2983275

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Fetal atrial flutter associated with maternal beta-sympathomimetic drug exposure. Author(s): Baker ER, Flanagan MF. Source: Obstetrics and Gynecology. 1997 May; 89(5 Pt 2): 861. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9166355

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Fetal atrial flutter recorded prenatally by magnetocardiography. Author(s): Hosono T, Kanagawa T, Chiba Y, Neki R, Kandori A, Tsukada K. Source: Fetal Diagnosis and Therapy. 2002 March-April; 17(2): 75-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11844909

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Fetal atrial flutter: diagnosis, clinical features, treatment, and outcome. Author(s): Jaeggi E, Fouron JC, Drblik SP. Source: The Journal of Pediatrics. 1998 February; 132(2): 335-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9506651

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Flecainide acetate in atrial flutter and fibrillation. The arrhythmogenic effects. Author(s): Sihm I, Hansen FA, Rasmussen J, Pedersen AK, Thygesen K. Source: European Heart Journal. 1990 February; 11(2): 145-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2107078

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Focal right atrial dysplasia and atrial flutter in a patient with myotonic dystrophy. Author(s): Pickering JG, Guiraudon C, Klein GJ. Source: Pacing and Clinical Electrophysiology : Pace. 1989 August; 12(8): 1317-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2476755

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Fragmented electrograms and continuous electrical activity in atrial flutter. Author(s): Cosio FG, Arribas F, Palacios J, Tascon J, Lopez-Gil M. Source: The American Journal of Cardiology. 1986 June 1; 57(15): 1309-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3717031

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Frequency and implications of resetting and entrainment with right atrial stimulation in atrial flutter. Author(s): Arenal A, Almendral J, San Roman D, Delcan JL, Josephson ME. Source: The American Journal of Cardiology. 1992 November 15; 70(15): 1292-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1442580

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Frequency of subacute resumption of isthmus conduction after ablation of atrial flutter. Author(s): Mittal S, Das MK, Stein KM, Markowitz SM, Slotwiner DJ, Scheiner MA, Iwai S, Lerman BB. Source: The American Journal of Cardiology. 2001 May 1; 87(9): 1113-6, A9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11348615

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Functional characterization of the crista terminalis in patients with atrial flutter: implications for radiofrequency ablation. Author(s): Liu TY, Tai CT, Huang BH, Higa S, Lin YJ, Huang JL, Yuniadi Y, Lee PC, Ding YA, Chen SA. Source: Journal of the American College of Cardiology. 2004 May 5; 43(9): 1639-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15120825

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Atrial Flutter

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Global right atrial mapping delineates double posterior lines of block in patients with typical atrial flutter: a study using a three dimensional noncontact mapping system. Author(s): Chen J, Hoff PI, Erga KS, Rossvoll O, Ohm OJ. Source: Journal of Cardiovascular Electrophysiology. 2003 October; 14(10): 1041-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14521656

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Global right atrial mapping of human atrial flutter: the presence of posteromedial (sinus venosa region) functional block and double potentials : a study in biplane fluoroscopy and intracardiac echocardiography. Author(s): Friedman PA, Luria D, Fenton AM, Munger TM, Jahangir A, Shen WK, Rea RF, Stanton MS, Hammill SC, Packer DL. Source: Circulation. 2000 April 4; 101(13): 1568-77. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10747351

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Heart sounds in atrial flutter-fibrillation. Author(s): Neporent LM, Da Silva JA. Source: The American Journal of Cardiology. 1967 February; 19(2): 301-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6016432

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Hearts that go thump in the night. Positional atrial flutter in a patient with mitralvalve prolapse. Author(s): Desser KB, DeSa'Neto A, Benchimol A. Source: The New England Journal of Medicine. 1979 March 29; 300(13): 717-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=763301

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Hemodynamic changes during cardioversion in utero: a case report of supraventricular tachycardia and atrial flutter. Author(s): Kanzaki T, Murakami M, Kobayashi H, Takahashi S, Chiba Y. Source: Fetal Diagnosis and Therapy. 1993 January-February; 8(1): 37-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8452647

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High energy radiofrequency catheter ablation for common atrial flutter targeting the isthmus between the inferior vena cava and tricuspid valve annulus using a super long tip electrode. Author(s): Iesaka Y, Takahashi A, Goya M, Yamane T, Tokunaga T, Amemiya H, Fujiwara H, Nitta J, Nogami A, Aonuma K, Hiroe M, Marumo F, Hiraoka M. Source: Pacing and Clinical Electrophysiology : Pace. 1998 February; 21(2): 401-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9507541

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High resolution recordings of atrial flutter. Author(s): Baciarello G, Di Maio F, Russo GE, Sciacca A. Source: Pacing and Clinical Electrophysiology : Pace. 1983 March; 6(2 Pt 1): 268-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6189067

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High reversion of atrial flutter to sinus rhythm after atrial pacing in patients with pulmonary disease. Author(s): Orlando J, Cassidy J, Aronow WS. Source: Chest. 1977 May; 71(5): 580-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=856555

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How is atrial tachycardia differentiated from atrial flutter? Author(s): Ide B, Drew BJ. Source: Progress in Cardiovascular Nursing. 2000 Fall; 15(4): 151, 153. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11098529

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How to ablate typical atrial flutter. Author(s): Takahashi A, Shah DC, Jais P, Haissaguerre M. Source: Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 1999 July; 1(3): 151-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11225789

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Hyperthyroid-induced atrial flutter-fibrillation with profound sinoatrial nodal pauses due to small doses of digoxin, verapamil, and propranolol. Author(s): Talley JD, Wathen MS, Hurst JW. Source: Clin Cardiol. 1989 January; 12(1): 45-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2912608

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Hypoglycaemia and atrial flutter. Author(s): Fisher BM, Marshall DA, MacCuish AC. Source: Postgraduate Medical Journal. 1991 December; 67(794): 1083. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1800970

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Ibutilide for cardioversion of atrial flutter: efficacy of a single dose in recent-onset arrhythmias. Author(s): Ando G, Di Rosa S, Rizzo F, Carerj S, Bramanti O, Giannetto M, Arrigo F. Source: Minerva Cardioangiol. 2004 February; 52(1): 37-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14765036

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Atrial Flutter

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Ibutilide in rapid conversion of atrial flutter in octogenarians. Author(s): Antonicelli R, Testarmata P, Recanatini A. Source: Drugs & Aging. 2002; 19(10): 787-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12390055

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Ibutilide: a class III rapidly acting antidysrhythmic for atrial fibrillation or atrial flutter. Author(s): Rogers KC, Wolfe DA. Source: The Journal of Emergency Medicine. 2001 January; 20(1): 67-71. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11165840

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Ibutilide: efficacy and safety in atrial fibrillation and atrial flutter in a general cardiology practice. Author(s): Eversole A, Hancock W, Johns T, Lopez LM, Conti CR. Source: Clin Cardiol. 2001 July; 24(7): 521-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11444644

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Identification of extremely slow conduction in the cavotricuspid isthmus during common atrial flutter ablation. Author(s): Chen J, de Chillou C, Hoff PI, Rossvoll O, Andronache M, Sadoul N, MagninPoull I, Erga KS, Aliot E, Ohm OJ. Source: Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing. 2002 August; 7(1): 67-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12391422

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Identification of fetal atrial flutter by Doppler tissue imaging. Author(s): Cotton JL. Source: Circulation. 2001 September 4; 104(10): 1206-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11535581

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Impact of the ECG for detection of intraatrial conduction block after atrial flutter ablation. Author(s): Weiss C, Willems S, Hoffmann M, Meinertz T. Source: Pacing and Clinical Electrophysiology : Pace. 1999 October; 22(10): 1457-65. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10588147

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Impact of transisthmus linear ablation of typical atrial flutter on coronary sinus activation time. Author(s): Tsai CF, Chen SA, Tai CT, Chiang CE, Yu WC, Chen YJ, Feng AN, Hsieh MH, Ding YA, Chang MS. Source: Pacing and Clinical Electrophysiology : Pace. 2000 January; 23(1): 63-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10666755

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Implantable atrial defibrillator and detection of atrial flutter. Author(s): Schwartz M, Maglio C, Akhtar M, Sra J. Source: Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing. 2000 April; 4(1): 257-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10729843

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Importance of atrial flutter isthmus in postoperative intra-atrial reentrant tachycardia. Author(s): Chan DP, Van Hare GF, Mackall JA, Carlson MM, Waldo AL. Source: Circulation. 2000 September 12; 102(11): 1283-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10982544

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Incidence and clinical significance of ST segment elevation after electrical cardioversion of atrial fibrillation and atrial flutter. Author(s): Van Gelder IC, Crijns HJ, Van der Laarse A, Van Gilst WH, Lie KI. Source: American Heart Journal. 1991 January; 121(1 Pt 1): 51-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1985377

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Incidence and clinical significance of transformation of atrial fibrillation to atrial flutter in patients undergoing long-term antiarrhythmic drug treatment. Author(s): Riva S, Tondo C, Carbucicchio C, Galimberti P, Fassini G, Della Bella P. Source: Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 1999 October; 1(4): 242-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11220561

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Incidence and predictors of atrial flutter in the general population. Author(s): Granada J, Uribe W, Chyou PH, Maassen K, Vierkant R, Smith PN, Hayes J, Eaker E, Vidaillet H. Source: Journal of the American College of Cardiology. 2000 December; 36(7): 2242-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11127467

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Incidence of atrial flutter and atrial fibrillation in patients with implanted physiological pacemakers. Author(s): Ishikawa T, Sumita S, Kikuchi M, Nakagawa T, Kosuge M, Kuji N, Kimura K, Tochikubo O, Usui T, Umemura S. Source: Japanese Circulation Journal. 2000 July; 64(7): 505-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10929778

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Increased incidence of atrial flutter associated with the rejection of heart transplantation. Author(s): Cui G, Tung T, Kobashigawa J, Laks H, Sen L. Source: The American Journal of Cardiology. 2001 August 1; 88(3): 280-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11472708

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Atrial Flutter

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Influence of atrial flutter ablation on right to left inter-atrial conduction. Author(s): Fatemi M, Kirkorian G, Chevalier P, Lavaud P, Bellon C, Da Costa A, Bonnefoy E, Touboul P. Source: Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2001 January; 3(1): 64-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11271955

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Influence of right atrial structure on outcome of radio-frequency catheter ablation for common atrial flutter. Author(s): Ohba Y, Shimoike E, Ueda N, Maruyama T, Kaji Y, Fujino T, Niho Y. Source: Japanese Circulation Journal. 2000 October; 64(10): 741-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11059612

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Inter-relationships between atrial flutter and atrial fibrillation. Author(s): Waldo AL. Source: Pacing and Clinical Electrophysiology : Pace. 2003 July; 26(7 Pt 2): 1583-96. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12914607

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Is 8-mm more effective than 4-mm tip electrode catheter for ablation of typical atrial flutter? Author(s): Tsai CF, Tai CT, Yu WC, Chen YJ, Hsieh MH, Chiang CE, Ding YA, Chang MS, Chen SA. Source: Circulation. 1999 August 17; 100(7): 768-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10449701

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Is atrial flutter a risk factor for stroke? Author(s): Sparks PB, Kalman JM. Source: Journal of the American College of Cardiology. 2001 September; 38(3): 785-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11527634

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Large tip electrodes for successful elimination of atrial flutter resistant to conventional catheter ablation. Author(s): Ventura R, Willems S, Weiss C, Flecke J, Risius T, Rostock T, Hoffmann M, Meinertz T. Source: Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing. 2003 April; 8(2): 149-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12766507

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Late recurrence of atrial flutter following radiofrequency catheter ablation. Author(s): Cheema AN, Grais IM, Burke JH, Inbar S, Kadish AH, Goldberger JJ. Source: Pacing and Clinical Electrophysiology : Pace. 1997 December; 20(12 Pt 1): 29983001. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9455765

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Left atrial "stunning" following radiofrequency catheter ablation of chronic atrial flutter. Author(s): Sparks PB, Jayaprakash S, Vohra JK, Mond HG, Yapanis AG, Grigg LE, Kalman JM. Source: Journal of the American College of Cardiology. 1998 August; 32(2): 468-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9708477

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Left atrial appendage "stunning" after electrical cardioversion of atrial flutter: an attenuated response compared with atrial fibrillation as the mechanism for lower susceptibility to thromboembolic events. Author(s): Grimm RA, Stewart WJ, Arheart K, Thomas JD, Klein AL. Source: Journal of the American College of Cardiology. 1997 March 1; 29(3): 582-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9060897

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Left atrial appendage function and abnormal hypercoagulability in patients with atrial flutter. Author(s): Sakurai K, Hirai T, Nakagawa K, Kameyama T, Nozawa T, Asanoi H, Inoue H. Source: Chest. 2003 November; 124(5): 1670-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14605033

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Left atrial appendage function in patients with atrial flutter. Author(s): Omran H, Jung W, Rabahieh R, MacCarter D, Illien S, Rang B, Hagendorff A, Schimpf R, Luderitz B. Source: Heart (British Cardiac Society). 1997 September; 78(3): 250-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9391286

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Left atrial appendage thrombus in atrial flutter with no associated heart disease. Author(s): Sasson Z, Mangat I, Grande P, Lorrette I. Source: Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography. 1996 September-October; 9(5): 730-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8887881

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Left atrial flutter after radiofrequency catheter ablation of focal atrial fibrillation. Author(s): Villacastin J, Perez-Castellano N, Moreno J, Gonzalez R. Source: Journal of Cardiovascular Electrophysiology. 2003 April; 14(4): 417-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12741717

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Left atrial flutter after segmental ostial radiofrequency catheter ablation for pulmonary vein isolation. Author(s): Oral H, Knight BP, Morady F. Source: Pacing and Clinical Electrophysiology : Pace. 2003 June; 26(6): 1417-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12822760

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Left atrial impulse formation in atrial flutter. Author(s): Mirowski M, Alkan WJ. Source: British Heart Journal. 1967 May; 29(3): 299-304. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6023722

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Left-sided atrial flutter: characterization of a novel complication of pediatric lung transplantation in an acute canine model. Author(s): Gandhi SK, Bromberg BI, Schuessler RB, Boineau JP, Cox JL, Huddleston CB. Source: The Journal of Thoracic and Cardiovascular Surgery. 1996 October; 112(4): 9921001. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8873726

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Leptospirosis with atrial flutter (a case report). Author(s): D'Souza C, Dwivedi S, Balasubramanian R. Source: Journal of Postgraduate Medicine. 1990 October; 36(4): 222-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2132249

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Life-threatening alterations in heart rate after the use of adenosine in atrial flutter. Author(s): Brodsky MA, Hwang C, Hunter D, Chen PS, Smith D, Ariani M, Johnston WD, Allen BJ, Chun JG, Gold CR. Source: American Heart Journal. 1995 September; 130(3 Pt 1): 564-71. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7661076

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Linear ablation of the isthmus between the inferior vena cava and tricuspid annulus for the treatment of atrial flutter. A study in the canine atrial flutter model. Author(s): Tabuchi T, Okumura K, Matsunaga T, Tsunoda R, Jougasaki M, Yasue H. Source: Circulation. 1995 September 1; 92(5): 1312-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7648680

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LocaLisa catheter navigation reduces fluoroscopy time and dosage in ablation of atrial flutter: a prospective randomized study. Author(s): Schneider MA, Ndrepepa G, Dobran I, Schreieck J, Weber S, Plewan A, Deisenhofer I, Karch MR, Schomig A, Schmitt C. Source: Journal of Cardiovascular Electrophysiology. 2003 June; 14(6): 587-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12875418

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Long term follow up of radiofrequency catheter ablation of atrial flutter: clinical course and predictors of atrial fibrillation occurrence. Author(s): Bertaglia E, Zoppo F, Bonso A, Proclemer A, Verlato R, Coro L, Mantovan R, D'Este D, Zerbo F, Pascotto P; Northeastern Italian Study on Atrial Flutter Ablation Investigators. Source: Heart (British Cardiac Society). 2004 January; 90(1): 59-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14676244

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Long-term outcome of electrical cardioversion in patients with chronic atrial flutter. Author(s): Crijns HJ, Van Gelder IC, Tieleman RG, Brugemann J, De Kam PJ, Gosselink AT, Bink-Boelkens MT, Lie KI. Source: Heart (British Cardiac Society). 1997 January; 77(1): 56-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9038696

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Long-term outcome of patients after successful radiofrequency ablation for typical atrial flutter. Author(s): Gilligan DM, Zakaib JS, Fuller I, Shepard RK, Dan D, Wood MA, Clemo HF, Stambler BS, Ellenbogen KA. Source: Pacing and Clinical Electrophysiology : Pace. 2003 January; 26(1 Pt 1): 53-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12685140

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Long-term outcome of patients with drug-refractory atrial flutter and fibrillation after single- and dual-site right atrial pacing for arrhythmia prevention. Author(s): Delfaut P, Saksena S, Prakash A, Krol RB. Source: Journal of the American College of Cardiology. 1998 December; 32(7): 1900-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9857870

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Long-term outcome of radiofrequency catheter ablation for typical atrial flutter: risk prediction of recurrent arrhythmias. Author(s): Tai CT, Chen SA, Chiang CE, Lee SH, Wen ZC, Huang JL, Chen YJ, Yu WC, Feng AN, Lin YJ, Ding YA, Chang MS. Source: Journal of Cardiovascular Electrophysiology. 1998 February; 9(2): 115-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9511885

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Macroreentrant atrial flutter around a common atrioventricular canal in an infant with complicated congenital heart anomaly. Author(s): Satomi K, Shimizu W, Suyama K, Echigo S, Kamakura S. Source: Pacing and Clinical Electrophysiology : Pace. 2002 October; 25(10): 1530-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12418755

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Maintenance of sinus rhythm with oral d,l-sotalol therapy in patients with symptomatic atrial fibrillation and/or atrial flutter. d,l-Sotalol Atrial Fibrillation/Flutter Study Group. Author(s): Benditt DG, Williams JH, Jin J, Deering TF, Zucker R, Browne K, Chang-Sing P, Singh BN. Source: The American Journal of Cardiology. 1999 August 1; 84(3): 270-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10496434

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Management of atrial flutter. Author(s): Niebauer MJ, Chung MK. Source: Cardiology in Review. 2001 September-October; 9(5): 253-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11520448

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Management of atrial flutter. Author(s): Kongsgaard E, Aass H. Source: Current Cardiology Reports. 2000 July; 2(4): 314-21. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10953265

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Mechanism and location of atrial flutter in transplanted hearts: observations during transient entrainment from distant sites. Author(s): Arenal A, Almendral J, Munoz R, Villacastin J, Merino JL, Palomo J, Garcia Robles JA, Peinado R, Delcan JL. Source: Journal of the American College of Cardiology. 1997 August; 30(2): 539-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9247530

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Mechanism of conversion of atypical right atrial flutter to atrial fibrillation. Author(s): Yang Y, Mangat I, Glatter KA, Cheng J, Scheinman MM. Source: The American Journal of Cardiology. 2003 January 1; 91(1): 46-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12505570

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Mechanism of induction of atrial flutter. Author(s): Keane D, Ruskin JN. Source: Journal of Cardiovascular Electrophysiology. 1999 October; 10(10): 1432. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10515570

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Mechanism of initiation of atrial flutter in humans: site of unidirectional block and direction of rotation. Author(s): Olgin JE, Kalman JM, Saxon LA, Lee RJ, Lesh MD. Source: Journal of the American College of Cardiology. 1997 February; 29(2): 376-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9014992

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Mechanism of spontaneous transition from typical atrial flutter to atrial fibrillation: role of ectopic atrial fibrillation foci. Author(s): Hsieh MH, Tai CT, Tsai CF, Yu WC, Lin WS, Huang JL, Ding YA, Chang MS, Chen SA. Source: Pacing and Clinical Electrophysiology : Pace. 2001 January; 24(1): 46-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11227968

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Mechanisms and clinical implications of atypical atrial flutter. Author(s): Scheinman MM, Cheng J, Yang Y. Source: Journal of Cardiovascular Electrophysiology. 1999 August; 10(8): 1153-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10466496

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Mechanisms and medical management of patients with atrial flutter. Author(s): Waldo AL, Mackall JA, Biblo LA. Source: Cardiology Clinics. 1997 November; 15(4): 661-76. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9403167

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Mechanisms of antiarrhythmic drug action on termination of atrial flutter. Author(s): Tai CT, Chen SA. Source: Pacing and Clinical Electrophysiology : Pace. 2001 May; 24(5): 824-34. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11388102

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Mechanisms of atrial flutter and atrial fibrillation: distinct entities or two sides of a coin? Author(s): Waldo AL. Source: Cardiovascular Research. 2002 May; 54(2): 217-29. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12062328

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Mechanisms of atrial flutter: implications for ablative therapy. Author(s): Waldo AL. Source: Journal of Interventional Cardiology. 1995 December; 8(6): 701-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10159762

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Mechanisms of induction of typical and reversed atrial flutter. Author(s): Cosio FG, Lopez-Gil M, Arribas F, Gonzalez HD. Source: Journal of Cardiovascular Electrophysiology. 1998 March; 9(3): 281-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9554733

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Microwave ablation of atrial flutter. Author(s): Adragao P, Parreira L, Morgado F, Bonhorst D, Seabra-Gomes R. Source: Pacing and Clinical Electrophysiology : Pace. 1999 November; 22(11): 1692-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10598976

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Mode switching failure during atrial flutter: the '2:1 lock-in' phenomenon. Author(s): Goethals M, Timmermans W, Geelen P, Backers J, Brugada P. Source: Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2003 January; 5(1): 95-102. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12504648

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Modification of the maze procedure for atrial flutter and atrial fibrillation. I. Rationale and surgical results. Author(s): Cox JL, Boineau JP, Schuessler RB, Jaquiss RD, Lappas DG. Source: The Journal of Thoracic and Cardiovascular Surgery. 1995 August; 110(2): 47384. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7637365

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Modification of the maze procedure for atrial flutter and atrial fibrillation. II. Surgical technique of the maze III procedure. Author(s): Cox JL, Jaquiss RD, Schuessler RB, Boineau JP. Source: The Journal of Thoracic and Cardiovascular Surgery. 1995 August; 110(2): 48595. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7637366

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Monitoring the local electrogram at the ablation site during radiofrequency application for common atrial flutter. Author(s): Azegami K, Satake S, Okishige K, Sasano T, Ohira H, Yamashita K. Source: Japanese Circulation Journal. 1998 August; 62(8): 559-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9741731

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Natural history of isolated atrial flutter in infancy. Author(s): Mendelsohn A, Dick M 2nd, Serwer GA. Source: The Journal of Pediatrics. 1991 September; 119(3): 386-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1880651

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Neonatal atrial flutter: significant early morbidity and excellent long-term prognosis. Author(s): Casey FA, McCrindle BW, Hamilton RM, Gow RM. Source: American Heart Journal. 1997 March; 133(3): 302-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9060798

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New antiarrhythmic agents for atrial fibrillation and atrial flutter: United States drug market response as an indicator of acceptance. Author(s): LaPointe NM, Pamer CA, Kramer JM. Source: Pharmacotherapy. 2003 October; 23(10): 1316-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14594348

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New antiarrhythmic drugs for atrial flutter and atrial fibrillation: a conceptual breakthrough at last? Author(s): Cosio FG, Delpon E. Source: Circulation. 2002 January 22; 105(3): 276-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11804977

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New approaches for the management of atrial fibrillation: role of ablation of atrial flutter. Author(s): Feld GK. Source: Journal of Cardiovascular Electrophysiology. 1999 September; 10(9): 1188-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10517650

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New approaches to treatment of atrial flutter and tachycardia. Author(s): Lesh MD, Kalman JM, Olgin JE. Source: Journal of Cardiovascular Electrophysiology. 1996 April; 7(4): 368-81. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8777486

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New electrocardiographic criteria for the differentiation between counterclockwise and clockwise atrial flutter: correlation with electrophysiological study and radiofrequency catheter ablation. Author(s): Lai LP, Lin JL, Lin LJ, Chen WJ, Ho YL, Tseng YZ, Chen CH, Lee YT, Lien WP, Huang SK. Source: Heart (British Cardiac Society). 1998 July; 80(1): 80-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9764066

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New onset atrial flutter termination by overdrive transoesophageal pacing: effects of different protocols of stimulation. Author(s): Doni F, Manfredi M, Piemonti C, Staffiere E, Todd S, Rimondini A, Fiorentini C. Source: Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2000 October; 2(4): 292-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11194595

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Nomenclature and characterization of transisthmus conduction after ablation of typical atrial flutter. Author(s): Cosio FG, Anderson RH, Kuck KH. Source: Pacing and Clinical Electrophysiology : Pace. 1998 April; 21(4 Pt 1): 777-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9584315

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Nomenclature and characterization of transisthmus conduction after ablation of typical atrial flutter. Author(s): Barold SS, Shah D, Jais P, Takahashi A, Haissaguerre M, Clementy J. Source: Pacing and Clinical Electrophysiology : Pace. 1997 July; 20(7): 1751-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9249826

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Noncontact mapping-guided ablation of atrial flutter and enhanced-density mapping of the inferior vena caval-tricuspid annulus isthmus. Author(s): Schneider MA, Ndrepepa G, Zrenner B, Karch MR, Schmieder S, Deisenhofer I, Schreieck J, Schomig A, Schmitt C. Source: Pacing and Clinical Electrophysiology : Pace. 2001 December; 24(12): 1755-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11817809

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Noninvasive conversion of atrial flutter using a multiprogrammable DDD pulse generator. Author(s): Luceri RM, Castellanos A, Thurer RJ, Myerburg RJ. Source: Pacing and Clinical Electrophysiology : Pace. 1986 January; 9(1 Pt 1): 137-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2419845

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Noninvasive diagnosis and treatment of atrial flutter utilizing previously implanted dual chamber pacemaker. Author(s): Hassett JA, Elrod PA, Arciniegas JG, Maclean WA, Duncan JL. Source: Pacing and Clinical Electrophysiology : Pace. 1988 November; 11(11 Pt 2): 16626. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2463529

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Noninvasive, direct visualization of macro-reentrant circuits by using magnetocardiograms: initiation and persistence of atrial flutter. Author(s): Yamada S, Tsukada K, Miyashita T, Kuga K, Yamaguchi I. Source: Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2003 October; 5(4): 343-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14753628

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Nonlinear ablation targeting an isthmus of critically slow conduction detected by high-density electroanatomical mapping for atypical atrial flutter. Author(s): Iesaka Y, Takahashi A, Goya M, Fujiwara H, Nitta J, Nogami A, Aonuma K, Hiroe M, Marumo F, Hiraoka M. Source: Pacing and Clinical Electrophysiology : Pace. 2000 November; 23(11 Pt 2): 19115. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11139956

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Nonpharmacologic approaches to the treatment of atrial fibrillation and atrial flutter. Author(s): Baker BM, Smith JM, Cain ME. Source: Journal of Cardiovascular Electrophysiology. 1995 October; 6(10 Pt 2): 972-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8548118

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Nonpharmacologic treatment of common atrial flutter guided by transient entrainment. Author(s): Fujimoto T, Itoh S, Takaoka K, Kurogane H, Yoshida Y, Kawamura T, Ogawa K, Inoue T, Yokoyama M. Source: Japanese Circulation Journal. 1993 March; 57(3): 215-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8464142

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Nonsustained atrial flutter in a child without congenital heart disease. Author(s): Casta A. Source: Clin Cardiol. 1985 October; 8(10): 545-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4053435

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Normal and prosthetic atrioventricular valve motion in atrial flutter. Correlation of ultrasound, vectrocardiographic, and phonocardiographic findings. Author(s): Alderman EL, Rytand DA, Crow RS, Finegan RE, Harrison DC. Source: Circulation. 1972 June; 45(6): 1206-15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5032818

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On the path of the excitation wave in atrial flutter. Author(s): Stibitz GR, Rytand DA. Source: Circulation. 1968 January; 37(1): 75-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5634732

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Optimizing the detection of bidirectional block across the flutter isthmus for patients with typical isthmus-dependent atrial flutter. Author(s): Mangat I, Tschopp DR Jr, Yang Y, Cheng J, Keung EC, Scheinman MM. Source: The American Journal of Cardiology. 2003 March 1; 91(5): 559-64. Erratum In: Am J Cardiol. 2003 September 1; 92(5): 650. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12615260

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Oral N-acetylprocainamide compared to quinidine plus digoxin in the chronic suppression of atrial flutter in humans. Author(s): Feld GK, Nademanee K, Noll E, Singh BN. Source: Cardiovascular Drugs and Therapy / Sponsored by the International Society of Cardiovascular Pharmacotherapy. 1989 April; 3(2): 191-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2484856

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Overdrive atrial pacing for conversion of atrial flutter: comparison of postoperative with nonpostoperative patients. Author(s): Peters RW, Shorofsky SR, Pelini M, Olsovsky M, Gold MR. Source: American Heart Journal. 1999 January; 137(1): 100-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9878941

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Overdrive pacing for atrial flutter. Author(s): Peters RW, Weiss DN, Carliner NH, Feliciano Z, Shorofsky SR, Gold MR. Source: The American Journal of Cardiology. 1994 November 15; 74(10): 1021-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7977040

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Oversensing of atrial flutter in the recipient atrium of a heart transplant patient with a permanent atrial pacemaker. Author(s): Woodard DA, Conti JB, Curtis AB. Source: Clin Cardiol. 1996 July; 19(7): 597-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8818444

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Persistent atrial flutter in patients treated for atrial fibrillation with amiodarone and propafenone: electrophysiologic characteristics, radiofrequency catheter ablation, and risk prediction. Author(s): Tai CT, Chiang CE, Lee SH, Chen YJ, Yu WC, Feng AN, Ding YA, Chang MS, Chen SA. Source: Journal of Cardiovascular Electrophysiology. 1999 September; 10(9): 1180-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10517649

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Pharmacologic versus direct-current electrical cardioversion of atrial flutter and fibrillation. Author(s): Van Gelder IC, Tuinenburg AE, Schoonderwoerd BS, Tieleman RG, Crijns HJ. Source: The American Journal of Cardiology. 1999 November 4; 84(9A): 147R-151R. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10568674

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Phased-array intracardiac echocardiography for defining cavotricuspid isthmus anatomy during radiofrequency ablation of typical atrial flutter. Author(s): Morton JB, Sanders P, Davidson NC, Sparks PB, Vohra JK, Kalman JM. Source: Journal of Cardiovascular Electrophysiology. 2003 June; 14(6): 591-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12875419

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Predictors of atrial flutter with 1:1 conduction in patients treated with class I antiarrhythmic drugs for atrial tachyarrhythmias. Author(s): Brembilla-Perrot B, Houriez P, Beurrier D, Claudon O, Terrier de la Chaise A, Louis P. Source: International Journal of Cardiology. 2001 August; 80(1): 7-15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11532541

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Predictors of success in radiofrequency catheter ablation of atrial flutter. Author(s): Schumacher B, Wolpert C, Lewalter T, Vahlhaus C, Jung W, Luderitz B. Source: Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing. 2000 January; 4 Suppl 1: 121-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10590499

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Prevalence of left atrial chamber and appendage thrombi in patients with atrial flutter and its clinical significance. Author(s): Schmidt H, von der Recke G, Illien S, Lewalter T, Schimpf R, Wolpert C, Becher H, Luderitz B, Omran H. Source: Journal of the American College of Cardiology. 2001 September; 38(3): 778-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11527633

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Primary closed cooled tip ablation of typical atrial flutter in comparison to conventional radiofrequency ablation. Author(s): Spitzer SG, Karolyi L, Rammler C, Otto T. Source: Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2002 July; 4(3): 265-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12134972

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Prognostic differences between atrial fibrillation and atrial flutter. Author(s): Lelorier P, Humphries KH, Krahn A, Connolly SJ, Talajic M, Green M, Sheldon R, Dorian P, Newman D, Kerr CR, Yee R, Klein GJ. Source: The American Journal of Cardiology. 2004 March 1; 93(5): 647-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14996602

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Progressive ECG changes before the onset of atrial flutter in adult congenital heart disease patients. Author(s): Li W, Xiao HB, Henein MY, Somerville J, Gibson DG. Source: Heart (British Cardiac Society). 2001 June; 85(6): 703. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11359758

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Progressive isthmus delay during atrial flutter ablation: the critical importance of isthmus spanning electrodes for distinguishing pseudoblock from block. Author(s): Friedman PA, Luria D, Munger TM, Jahangir A, Shen WK, Rea RF, Grice S, Asirvatham S, Packer DL, Hammill SC. Source: Pacing and Clinical Electrophysiology : Pace. 2002 March; 25(3): 308-15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11990660

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Prolonged asystole following direct-current cardioversion for atrial flutter. Author(s): McMullan R, Morgan DR, O'Keeffe DB, Silke B. Source: Ulster Med J. 2001 November; 70(2): 158-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11795770

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Prolonged ventricular asystole, sinus arrest, and paroxysmal atrial flutter-fibrillation: an uncommon presentation of vasovagal syncope. Author(s): Chou HH, Lin KH, Luqman N, Kuo CT. Source: Pacing and Clinical Electrophysiology : Pace. 2003 April; 26(4 Pt 1): 914-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12715855

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Pronounced effect of procainamide on clockwise right atrial isthmus conduction compared with counterclockwise conduction: possible mechanism of the greater incidence of common atrial flutter during antiarrhythmic therapy. Author(s): Morita N, Kobayashi Y, Iwasaki YK, Hayashi M, Atarashi H, Katoh T, Takano T. Source: Journal of Cardiovascular Electrophysiology. 2002 March; 13(3): 212-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11942585

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Prophylactic anticoagulation of atrial flutter prior to cardioversion: meeting the "burden of proof". Author(s): Silverman DI, Manning WJ. Source: The American Journal of Medicine. 2001 October 15; 111(6): 493-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11690577

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Prospective evaluation of a simplified approach for common atrial flutter radio frequency ablation with only two catheters. Author(s): Klug D, Lacroix D, Marquie C, Mairesse G, Alix D, Dennetiere S, d'Hautefeuille B, Zghal N, Kacet S. Source: Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2001 July; 3(3): 208-15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11467462

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Prospective evaluation of catheter ablation in patients with implantable cardioverter defibrillators and multiple inappropriate ICD therapies due to atrial fibrillation and type I atrial flutter. Author(s): Korte T, Niehaus M, Meyer O, Tebbenjohanns J. Source: Pacing and Clinical Electrophysiology : Pace. 2001 July; 24(7): 1061-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11475820

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Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter. Author(s): Natale A, Newby KH, Pisano E, Leonelli F, Fanelli R, Potenza D, Beheiry S, Tomassoni G. Source: Journal of the American College of Cardiology. 2000 June; 35(7): 1898-904. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10841241

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Prospective randomized comparison of closed cooled-tip versus 8-mm-tip catheters for radiofrequency ablation of typical atrial flutter. Author(s): Schreieck J, Zrenner B, Kumpmann J, Ndrepepa G, Schneider MA, Deisenhofer I, Schmitt C. Source: Journal of Cardiovascular Electrophysiology. 2002 October; 13(10): 980-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12435182

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Prospective randomized comparison of cooled radiofrequency versus standard radiofrequency energy for ablation of typical atrial flutter. Author(s): Atiga WL, Worley SJ, Hummel J, Berger RD, Gohn DC, Mandalakas NJ, Kalbfleisch S, Halperin H, Donahue K, Tomaselli G, Calkins H, Daoud E. Source: Pacing and Clinical Electrophysiology : Pace. 2002 August; 25(8): 1172-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12358166

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Pulmonary edema after cardioversion for paroxysmal atrial flutter: left ventricular diastolic dysfunction induced by direct current shock. Author(s): Kobayashi N, Takayama M, Yamaura S, Ushimaru H, Ochi T, Saito M. Source: Japanese Circulation Journal. 2000 January; 64(1): 76-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10651211

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Quantitative analysis of surface P-wave morphology in isthmus ablation for type 1 atrial flutter: differentiation between complete isthmus block and slow isthmus conduction. Author(s): Tada H, Nogami A, Naito S, Horie Y, Suguta M, Nakatsugawa M, Hoshizaki H, Oshima S, Taniguchi K. Source: Japanese Circulation Journal. 1999 April; 63(4): 244-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10475770

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Radiofrequency ablation of atrial flutter: a randomized controlled study of two anatomic approaches. Author(s): Passman RS, Kadish AH, Dibs SR, Engelstein ED, Goldberger JJ. Source: Pacing and Clinical Electrophysiology : Pace. 2004 January; 27(1): 83-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14720160

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Radiofrequency catheter ablation of "typical" atrial flutter in a patient with Kartagener's syndrome. Author(s): Huang FR, Hau DK, Lee MA. Source: Pacing and Clinical Electrophysiology : Pace. 2002 July; 25(7): 1138-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12164458

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Radiofrequency catheter ablation of atypical atrial flutter masquerading as atrial fibrillation. Author(s): Dyrud M, Shellaberger H, Nawman R, West G, Kusumoto FM. Source: Pacing and Clinical Electrophysiology : Pace. 2002 December; 25(12): 1777-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12520682

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Radiofrequency catheter ablation of type 1 atrial flutter using large-tip 8- or 10-mm electrode catheters and a high-output radiofrequency energy generator: results of a multicenter safety and efficacy study. Author(s): Feld G, Wharton M, Plumb V, Daoud E, Friehling T, Epstein L; EPT-1000 XP Cardiac Ablation System Investigators. Source: Journal of the American College of Cardiology. 2004 April 21; 43(8): 1466-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15093885

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Randomized comparison of anatomic and electrogram mapping approaches to ablation of typical atrial flutter. Author(s): Tada H, Oral H, Ozaydin M, Chugh A, Scharf C, Hassan S, Greenstein R, Pelosi F Jr, Knight BP, Strickberger SA, Morady F. Source: Journal of Cardiovascular Electrophysiology. 2002 July; 13(7): 662-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12139288

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Randomized study comparing combined pulmonary vein-left atrial junction disconnection and cavotricuspid isthmus ablation versus pulmonary vein-left atrial junction disconnection alone in patients presenting with typical atrial flutter and atrial fibrillation. Author(s): Wazni O, Marrouche NF, Martin DO, Gillinov AM, Saliba W, Saad E, Klein A, Bhargava M, Bash D, Schweikert R, Erciyes D, Abdul-Karim A, Brachman J, Gunther J, Pisano E, Potenza D, Fanelli R, Natale A. Source: Circulation. 2003 November 18; 108(20): 2479-83. Epub 2003 Nov 10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14610012

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Randomized study comparing radiofrequency ablation with cryoablation for the treatment of atrial flutter with emphasis on pain perception. Author(s): Timmermans C, Ayers GM, Crijns HJ, Rodriguez LM. Source: Circulation. 2003 March 11; 107(9): 1250-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12628943

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Rapid magnetic electroanatomic mapping of typical atrial flutter using a novel multielectrode catheter. Author(s): Chauhan VS, Downer E, Shah P. Source: Journal of Cardiovascular Electrophysiology. 2003 June; 14(6): 673. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12875433

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Rate-dependent slow conduction velocity in the cavo-tricuspid isthmus and septum in patients with atrial flutter. Author(s): Fang P, Radtke NL, Simmons TW, Haisty WK Jr, Fitzgerald DM. Source: Chinese Medical Sciences Journal = Chung-Kuo I Hsueh K'o Hsueh Tsa Chih / Chinese Academy of Medical Sciences. 2003 June; 18(2): 75-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12903786

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Recurrence rate of atrial flutter after initial presentation in patients on drug treatment. Author(s): Babaev A, Suma V, Tita C, Steinberg JS. Source: The American Journal of Cardiology. 2003 November 1; 92(9): 1122-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14583371

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Recurrent atrial flutter and atrial fibrillation after catheter ablation of the cavotricuspid isthmus: a very long-term follow-up of 333 patients. Author(s): Hsieh MH, Tai CT, Chiang CE, Tsai CF, Yu WC, Chen YJ, Ding YA, Chen SA. Source: Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing. 2002 December; 7(3): 225-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12510133

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Relation between transverse conduction capability and the anatomy of the crista terminalis in patients with atrial flutter and atrial fibrillation: analysis by intracardiac echocardiography. Author(s): Mizumaki K, Fujiki A, Nagasawa H, Nishida K, Sakabe M, Sakurai K, Inoue H. Source: Circulation Journal : Official Journal of the Japanese Circulation Society. 2002 December; 66(12): 1113-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12499616

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Relationship between left atrial appendage function and left atrial thrombus in patients with nonvalvular chronic atrial fibrillation and atrial flutter. Author(s): Narumiya T, Sakamaki T, Sato Y, Kanmatsuse K. Source: Circulation Journal : Official Journal of the Japanese Circulation Society. 2003 January; 67(1): 68-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12520155

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Relationship between polarity of the flutter wave in the surface ECG and endocardial atrial activation sequence in patients with typical counterclockwise and clockwise atrial flutter. Author(s): Oshikawa N, Watanabe I, Masaki R, Okumura Y, Okubo K, Sugimura H, Kojima T, Saito S, Ozawa Y, Kanmatsuse K. Source: Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing. 2002 December; 7(3): 215-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12510132

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Relationship between surface electrocardiogram characteristics and endocardial activation sequence in patients with typical atrial flutter. Author(s): Ndrepepa G, Zrenner B, Deisenhofer I, Karch M, Schneider M, Schreieck J, Schmitt C. Source: Zeitschrift Fur Kardiologie. 2000 June; 89(6): 527-37. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10929438

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Remodeling of sinus node function after catheter ablation of right atrial flutter. Author(s): Daoud EG, Weiss R, Augostini RS, Kalbfleisch SJ, Schroeder J, Polsinelli G, Hummel JD. Source: Journal of Cardiovascular Electrophysiology. 2002 January; 13(1): 20-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11843478

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Repetitive atrial flutter as a complication of the left-sided simple maze procedure. Author(s): Usui A, Inden Y, Mizutani S, Takagi Y, Akita T, Ueda Y. Source: The Annals of Thoracic Surgery. 2002 May; 73(5): 1457-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12022533

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Review of diagnosis, treatment, and outcome of fetal atrial flutter compared with supraventricular tachycardia. Author(s): Krapp M, Kohl T, Simpson JM, Sharland GK, Katalinic A, Gembruch U. Source: Heart (British Cardiac Society). 2003 August; 89(8): 913-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12860871

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Right atrial flutter isthmus revisited: normal anatomy favors nonuniform anisotropic conduction. Author(s): Waki K, Saito T, Becker AE. Source: Journal of Cardiovascular Electrophysiology. 2000 January; 11(1): 90-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10695468

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Risk factors for recurrence of atrial fibrillation in patients undergoing hybrid therapy for antiarrhythmic drug-induced atrial flutter. Author(s): Reithmann C, Dorwarth U, Dugas M, Hahnefeld A, Ramamurthy S, Remp T, Steinbeck G, Hoffmann E. Source: European Heart Journal. 2003 July; 24(13): 1264-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12831821

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Safety and efficacy of radiofrequency ablation of common atrial flutter in elderly patients: a single center prospective study. Author(s): Da Costa A, Zarqane-Sliman N, Romeyer-Bouchard C, Gonthier R, Samuel B, Messier M, Khiel A, Isaaz K. Source: Pacing and Clinical Electrophysiology : Pace. 2003 August; 26(8): 1729-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12877707

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Safety and feasibility of a clinical pathway for the outpatient initiation of antiarrhythmic medications in patients with atrial fibrillation or atrial flutter. Author(s): Hauser TH, Pinto DS, Josephson ME, Zimetbaum P. Source: The American Journal of Cardiology. 2003 June 15; 91(12): 1437-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12804730

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Severe nodal arrhythmia following direct current cardioversion for atrial flutter. Author(s): Hansen MG, Gill SU, Hansen HS. Source: Scandinavian Cardiovascular Journal : Scj. 1999; 33(4): 250-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10517215

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Should ablation of atrial flutter be discouraged in patients with documented atrial fibrillation? Author(s): Della Bella P, Riva S, Galimberti P. Source: Cardiologia. 1999 May; 44(5): 439-42. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10389348

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Sick sinus syndrome disclosed by the successful radiofrequency catheter ablation of persistent common atrial flutter. Author(s): Ohno M, Nakasuga K, Okamoto K, Hayashida A, Yasuda Y, Arita T, Yamagata Y, Koga H, Kubota S, Ito H, Maruyama T, Kaji Y, Harada M. Source: Fukuoka Igaku Zasshi. 2002 July; 93(7): 121-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12229194

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Simple optical methods for the recognition of atrial flutter, especially at slow atrial rates. Author(s): Rytand DA, Frank A, Profant GR. Source: Circulation. 1966 July; 34(1): 111-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5940233

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Simulated myocardial infarction and slow atrial flutter due to cerebral embolism from a free left atrial thrombus. Author(s): Onat A, Sarioglu T, Ilerigelen B, Domanic-Ucisik N. Source: Japanese Heart Journal. 1991 January; 32(1): 153-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2038121

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Simulation of atrial flutter by rapid coronary sinus pacing. Author(s): Rosen KM, Lau SH, Damato AN. Source: American Heart Journal. 1969 November; 78(5): 635-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5348747

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Simultaneous occurrence of atrial fibrillation and atrial flutter. Author(s): Horvath G, Goldberger JJ, Kadish AH. Source: Journal of Cardiovascular Electrophysiology. 2000 August; 11(8): 849-58. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10969746

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Simultaneous surgical treatment of atrial septal defect and atrial flutter using a simple modification of the atrial incision. Author(s): Henglein D, Cauchemez B, Bloch G. Source: Cardiology in the Young. 1999 March; 9(2): 197-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10323521

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Sinus node recovery after 25 years of atrial flutter. Author(s): Palma EC, Vijayaraman P, Ferrick KJ, Gross JN, Kim SG, Fisher JD. Source: Pacing and Clinical Electrophysiology : Pace. 2001 August; 24(8 Pt 1): 1295-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11523621

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Spontaneous conversion of established atrial fibrillation. Clinical significance of a change to atrial flutter or to paroxysmal atrial tachycardia with AV block. Author(s): Taguchi JT, Ryan JM. Source: Archives of Internal Medicine. 1969 October; 124(4): 468-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5823016

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Spot welding the gap in atrial flutter ablation. Author(s): Friedman PA, Stanton MS. Source: Circulation. 1999 June 22; 99(24): 3206-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10377086

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Studies in human atrial flutter with the use of proximity electrodes. Author(s): Kishon Y, Smith RE. Source: Circulation. 1969 October; 40(4): 513-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5823548

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Study on the genesis of the double potential recorded in the high right atrium in atrial flutter and its role in the reentry circuit of atrial flutter. Author(s): Tanoiri T, Komatsu C, Ishinaga T, Tokuhisa Y, Makino H, Nomoto J, Mogi J, Okamura T. Source: American Heart Journal. 1991 January; 121(1 Pt 1): 57-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1985378

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Superiority of ibutilide (a new class III agent) over DL-sotalol in converting atrial flutter and atrial fibrillation. The Ibutilide/Sotalol Comparator Study Group. Author(s): Vos MA, Golitsyn SR, Stangl K, Ruda MY, Van Wijk LV, Harry JD, Perry KT, Touboul P, Steinbeck G, Wellens HJ. Source: Heart (British Cardiac Society). 1998 June; 79(6): 568-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10078083

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Surface electrocardiographic characteristics of right and left atrial flutter. Author(s): Bochoeyer A, Yang Y, Cheng J, Lee RJ, Keung EC, Marrouche NF, Natale A, Scheinman MM. Source: Circulation. 2003 July 8; 108(1): 60-6. Epub 2003 June 30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12835225

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Symptomatic improvement after radiofrequency catheter ablation for typical atrial flutter. Author(s): O'Callaghan PA, Meara M, Kongsgaard E, Poloniecki J, Luddington L, Foran J, Camm AJ, Rowland E, Ward DE. Source: Heart (British Cardiac Society). 2001 August; 86(2): 167-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11454833

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Syncope in patients with atrial flutter during treatment with class Ic antiarrhythmic drugs. Author(s): Kawabata M, Hirao K, Horikawa T, Suzuki K, Motokawa K, Suzuki F, Azegami K, Hiejima K. Source: Journal of Electrocardiology. 2001 January; 34(1): 65-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11239374

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The arrangement of muscle fibres in the region of the subthebesian fossa in the aspect of atrial flutter. Author(s): Kozlowski D, Owerczuk A, Piwko G, Piszczatowska G, Kozlowska M, Bigus K, Grzybiak M. Source: Folia Morphol (Warsz). 2002; 61(4): 283-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12725498

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The coincidence of fetal magnetocardiography and direct electrocardiography in a case of fetal atrial flutter due to intracardiac tumor. Author(s): Hosono T, Kanagawa T, Chiba Y, Kandori A, Tsukada K. Source: Fetal Diagnosis and Therapy. 2002 November-December; 17(6): 331-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12393960

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The natural history of lone atrial flutter. Author(s): Halligan SC, Gersh BJ, Brown RD Jr, Rosales AG, Munger TM, Shen WK, Hammill SC, Friedman PA. Source: Annals of Internal Medicine. 2004 February 17; 140(4): 265-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14970149

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The usefulness of surface 12-lead electrocardiogram to predict intra-atrial conduction block after successful atrial flutter ablation. Author(s): Mairesse GH, Lacroix D, Klug D, Le Franc P, Kouakam C, Kacet S. Source: Journal of Electrocardiology. 2003 July; 36(3): 227-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12942485

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Three-dimensional noncontact mapping defines two zones of slow conduction in the circuit of typical atrial flutter. Author(s): Chen J, Hoff PI, Erga KS, Rossvoll O, Ohm OJ. Source: Pacing and Clinical Electrophysiology : Pace. 2003 January; 26(1 Pt 2): 318-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12687837

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Thromboembolic complications after electrical cardioversion in patients with atrial flutter. Author(s): Elhendy A, Gentile F, Khandheria BK, Gersh BJ, Bailey KR, Montgomery SC, Seward JB, Tajik AJ. Source: The American Journal of Medicine. 2001 October 15; 111(6): 433-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11690567

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Thromboembolic risk of patients referred for radiofrequency catheter ablation of typical atrial flutter without prior appropriate anticoagulation therapy. Author(s): Gronefeld GC, Wegener F, Israel CW, Teupe C, Hohnloser SH. Source: Pacing and Clinical Electrophysiology : Pace. 2003 January; 26(1 Pt 2): 323-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12687838

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Time course for resolution of left atrial appendage stunning after catheter ablation of chronic atrial flutter. Author(s): Takami M, Suzuki M, Sugi K, Ikeda T. Source: Journal of the American College of Cardiology. 2003 June 18; 41(12): 2207-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12821249

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Transesophageal cardioversion of atrial flutter and atrial fibrillation using an electric balloon electrode system. Author(s): Zheng F, Qi X, Liu H, Kang N. Source: Chinese Medical Journal. 2003 September; 116(9): 1325-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14527358

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Treatment of atrial flutter and rapid atrial tachycardia with endocavitary atrial pacing. Author(s): Carasca E, Dobreanu D, Andone A, Cotoi S. Source: Rom J Intern Med. 1998 January-June; 36(1-2): 29-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10660966

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Ultrasonic Doppler auscultation of the heart, with observations on atrial flutter and fibrillation. Author(s): Abelson D. Source: Jama : the Journal of the American Medical Association. 1968 May 6; 204(6): 43843. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5694433

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Uncommon atrial flutter originating in the left atrioventricular groove: emergence after successful catheter ablation for a left concealed accessory pathway. Author(s): Kobayashi Y, Hayashi M, Miyauchi Y, Kawaguchi N, Ogura H, Saitoh H, Ino T, Atarashi H, Kishida H, Hayakawa H. Source: Japanese Circulation Journal. 1999 May; 63(5): 416-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10943627

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Unidirectional conduction block at cavotricuspid isthmus created by radiofrequency catheter ablation in patients with typical atrial flutter. Author(s): Matsushita T, Chun S, Liem LB, Friday KJ, Sung RJ. Source: Journal of Cardiovascular Electrophysiology. 2002 November; 13(11): 1098-102. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12475099

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Unipolar waveforms and monophasic action potentials in the characterization of slow conduction in human atrial flutter. Author(s): Fenelon G, Brugada P. Source: Pacing and Clinical Electrophysiology : Pace. 1998 December; 21(12): 2580-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9894648

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Use of different catheter ablation technologies for treatment of typical atrial flutter: acute results and long-term follow-up. Author(s): Marrouche NF, Schweikert R, Saliba W, Pavia SV, Martin DO, Dresing T, Cole C, Balaban K, Saad E, Perez-Lugones A, Bash D, Tchou P, Natale A. Source: Pacing and Clinical Electrophysiology : Pace. 2003 March; 26(3): 743-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12698676

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Usefulness of phased-array intracardiac echocardiography for the assessment of left atrial mechanical "stunning" in atrial flutter and comparison with multiplane transesophageal echocardiography(*). Author(s): Morton JB, Sanders P, Sparks PB, Morgan J, Kalman JM. Source: The American Journal of Cardiology. 2002 October 1; 90(7): 741-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12356388

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Usefulness of three-dimensional non-fluoroscopic mapping in the ablation of typical atrial flutter. Author(s): Leonelli FM, Tomassoni G, Richey M, Natale A. Source: Ital Heart J. 2002 June; 3(6): 360-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12116800

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Usefulness of unipolar electrograms to detect isthmus block after radiofrequency ablation of typical atrial flutter. Author(s): Villacastin J, Almendral J, Arenal A, Castellano NP, Gonzalez S, Ortiz M, Garcia J, Vallbona B, Moreno J, Portales JF, Torrecilla EG. Source: Circulation. 2000 December 19; 102(25): 3080-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11120698

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Using intracardiac catheter recordings from the His and proximal coronary sinus to distinguish isthmus conduction block during catheter ablation of type I atrial flutter. Author(s): Sarter BH, Callans DJ, Man DC, Coyne RF, Schwartzman D, Gottlieb CD, Marchlinski FE. Source: Pacing and Clinical Electrophysiology : Pace. 2000 April; 23(4 Pt 1): 516-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10793444

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Validation of double-spike electrograms as markers of conduction delay or block in atrial flutter. Author(s): Cosio FG, Arribas F, Barbero JM, Kallmeyer C, Goicolea A. Source: The American Journal of Cardiology. 1988 April 1; 61(10): 775-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3354440

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Variable atrioventricular block during atrial flutter: what is the mechanism? Author(s): Duytschaever M, Dierickx C, Tavernier R. Source: Journal of Cardiovascular Electrophysiology. 2002 September; 13(9): 950-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12380939

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Variable electrocardiographic characteristics of isthmus-dependent atrial flutter. Author(s): Milliez P, Richardson AW, Obioha-Ngwu O, Zimetbaum PJ, Papageorgiou P, Josephson ME. Source: Journal of the American College of Cardiology. 2002 September 18; 40(6): 112532. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12354439

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Various routes of septal propagation in common atrial flutter. Author(s): Date T, Abe K, Miyazaki H, Yamane T, Sugimoto K, Mogi J, Honda Y, Noma K, Ishikawa S, Mochizuki S. Source: Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing. 2003 December; 9(3): 317-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14618051

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Varying intensity of the first sound with atrial flutter. Author(s): Adams CW. Source: Dis Chest. 1967 April; 51(4): 437-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6021414

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Ventricular beats induce variations in cycle length of rapid (type II) atrial flutter in humans. Evidence of leading circle reentry. Author(s): Ravelli F, Disertori M, Cozzi F, Antolini R, Allessie MA. Source: Circulation. 1994 May; 89(5): 2107-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8181135

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Ventricular tachycardia as a complication of atrial flutter ablation. Author(s): Ramanna H, Derksen R, Elvan A, Simmers TA, Wittkampf FH, Hauer RN, Robles de Medina E. Source: Journal of Cardiovascular Electrophysiology. 2000 April; 11(4): 472-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10809502

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Verapamil in atrial fibrillation and atrial flutter. Author(s): Aronow WS, Landa D, Plasencia G, Wong R, Karlsberg RP, Ferlinz J. Source: Clinical Pharmacology and Therapeutics. 1979 November; 26(5): 578-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=498700

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Verapamil therapy of atrial fibrillation and atrial flutter following cardiac operation. Author(s): Plumb VJ, Karp RB, Kouchoukos NT, Zorn GL Jr, James TN, Waldo AL. Source: The Journal of Thoracic and Cardiovascular Surgery. 1982 April; 83(4): 590-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7038316

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Verapamil versus placebo in atrial fibrillation and atrial flutter. Author(s): Aronow WS, Ferlinz J. Source: Clinical and Investigative Medicine. Medecine Clinique Et Experimentale. 1980; 3(1-2): 35-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7009002

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What is the relationship of atrial flutter and fibrillation? Author(s): Roithinger FX, Lesh MD. Source: Pacing and Clinical Electrophysiology : Pace. 1999 April; 22(4 Pt 1): 643-54. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10234718

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What is this atrioventricular conduction abnormality occurring after electrical cardioversion for atrial flutter? Author(s): Thompson C, Tsiperfal A. Source: Progress in Cardiovascular Nursing. 2001 Summer; 16(3): 134-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11464438

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What is your diagnosis? Atrial flutter with 1:1 conduction and RBBB aberrancy. Author(s): Rivera Del Rio JR, Igartua Ponton I. Source: Bol Asoc Med P R. 1997 April-June; 89(4-6): 80-1. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9284604

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What's the difference between atrial fibrillation and atrial flutter? Author(s): Carlson MD. Source: Health News. 2004 January; 10(1): 16. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15002391

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What's your reading? Atrial flutter. Author(s): Abrams J. Source: Rocky Mt Med J. 1978 May-June; 75(3): 144, 167. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=675040

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CHAPTER 2. NUTRITION AND ATRIAL FLUTTER Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and atrial flutter.

Finding Nutrition Studies on Atrial Flutter The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.4 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “atrial flutter” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

4

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “atrial flutter” (or a synonym): •

Association of atrial flutter with orthodromic reciprocating fetal tachycardia. Source: Johnson, W H Dunnigan, A Fehr, P Benson, D W Am-J-Cardiol. 1987 February 1; 59(4): 374-5 0002-9149

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Effects of N-acetylprocainamide on experimental atrial flutter and atrial electrophysiologic properties in conscious dogs with sterile pericarditis: comparison with the effects of quinidine. Source: Okumura, K Waldo, A L J-Am-Coll-Cardiol. 1987 June; 9(6): 1332-8 0735-1097

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Intracardiac overdrive pacing as a treatment of atrial flutter in a horse. Author(s): Department of Internal Medicine and Clinical Biology of Large Animal, Faculty of Veterinary Medicine, University of Ghent, Merelbeke, Belgium. Source: Van Loon, G Jordaens, L Muylle, E Nollet, H Sustronck, B Vet-Rec. 1998 March 21; 142(12): 301-3 0042-4900

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Intravenous amiodarone bolus versus oral quinidine for atrial flutter and fibrillation after cardiac operations. Author(s): Department of Cardiology, Green Lane Hospital, Auckland, New Zealand. Source: McAlister, H F Luke, R A Whitlock, R M Smith, W M J-Thorac-Cardiovasc-Surg. 1990 May; 99(5): 911-8 0022-5223

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

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Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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CHAPTER 3. ALTERNATIVE MEDICINE AND ATRIAL FLUTTER Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to atrial flutter. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to atrial flutter and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “atrial flutter” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to atrial flutter: •

An unusual cause of new-onset atrial flutter: primary cardiac lymphoma. Author(s): Hayes D Jr, Liles DK, Sorrell VL. Source: Southern Medical Journal. 2003 August; 96(8): 799-802. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14515922

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Atrial flutter in a young man with a highly competitive and stressful occupation. Author(s): Dubrey SW, Kurbaan AS, Kaddoura S. Source: Postgraduate Medical Journal. 1999 March; 75(881): 175-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10448502

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Atrial flutter with 1:1 A-V conduction. Author(s): Chung EK.

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Source: W V Med J. 1970 August; 66(8): 257-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5293555 •

Atrial flutter with block--contraindication to use of lignocaine. Author(s): Adamson AR, Spracklen FH. Source: British Medical Journal. 1968 April 27; 2(599): 223-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5653032

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Atrial flutter with inapparent flutter waves on the surface electrocardiogram. Author(s): Luca C, Petrescu LP. Source: Acta Cardiol. 1985; 40(5): 477-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3878647

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Atrial flutter. Tracing an elusive arrhythmia. Author(s): Glasser SP, Martinez-Lopez JI. Source: Postgraduate Medicine. 1977 August; 62(2): 61-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=882470

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Atrial flutter-fibrillation with a-v block terminated by external countershock. Author(s): RUTLEDGE DI, ZOLL PM. Source: Lahey Clin Found Bull. 1963 July-September; 13: 76-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14078128

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Carotid sinus massage as a diagnostic and therapeutic tool for atrial flutterfibrillation. Author(s): Kirchhof CJ, Gorgels AP, Wellens HJ. Source: Pacing and Clinical Electrophysiology : Pace. 1998 June; 21(6): 1319-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9633079

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Combined amiodarone and silymarin treatment, but not amiodarone alone, prevents sustained atrial flutter in dogs. Author(s): Vereckei A, Zipes DP, Besch H Jr. Source: Journal of Cardiovascular Electrophysiology. 2003 August; 14(8): 861-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12890050

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EKG of the month. Atrial flutter with 2:1 ventricular response. Author(s): Campbell WB. Source: J Tenn Med Assoc. 1981 January; 74(1): 43-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7230791

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Electrogram polarity and cavotricuspid isthmus block during ablation of typical atrial flutter.

Alternative Medicine 59

Author(s): Tada H, Oral H, Sticherling C, Chough SP, Baker RL, Wasmer K, Kim MH, Pelosi F Jr, Michaud GF, Knight BP, Strickberger SA, Morady F. Source: Journal of Cardiovascular Electrophysiology. 2001 April; 12(4): 393-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11332556 •

Neonatal atrial flutter following fetal exposure to vibroacoustic stimulation. Author(s): Peleg D, Orvieto R, Sirota L, Ben-Rafael Z. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1999 January; 82(1): 1-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10192475

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Overdrive and programmed atrial electrostimulation in the study of the electrogenetic mechanism of atrial flutter in man. Author(s): Disertori M, Molinis G, Inama G, Vergara G, Del Favero A, Furlanello F. Source: Pacing and Clinical Electrophysiology : Pace. 1981 March; 4(2): 133-47. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6167938

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Pathophysiology of atrial flutter. Author(s): Daoud EG, Morady F. Source: Annual Review of Medicine. 1998; 49: 77-83. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9509250

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Pseudoatrial flutter: artifact simulating atrial flutter caused by a transcutaneous electrical nerve stimulator (TENS). Author(s): Weitz SH, Tunick PA, McElhinney L, Mitchell T, Kronzon I. Source: Pacing and Clinical Electrophysiology : Pace. 1997 December; 20(12 Pt 1): 3010-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9455769

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The influence of exercise on atrial flutter. Author(s): Gooch AS, Sumathisena DR. Source: Journal of Electrocardiology. 1975 January; 8(1): 39-48. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1110337

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Unusual lymphoma manifestations: case 2. Myocardial lymphoma presenting as atrial flutter. Author(s): Thompson MA, Harker-Murray A, Locketz AJ, Chareonthaitawee P. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2004 February 1; 22(3): 558-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14752079

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Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. PATENTS ON ATRIAL FLUTTER Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.5 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “atrial flutter” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on atrial flutter, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Atrial Flutter By performing a patent search focusing on atrial flutter, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 5Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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example of the type of information that you can expect to obtain from a patent search on atrial flutter: •

Ablation lead for atrial flutter Inventor(s): Sutton; Richard (London, GB) Assignee(s): Medtronic, Inc. (Minneapolis, MN) Patent Number: 6,443,950 Date filed: February 24, 2000 Abstract: The present invention provides an ablation lead for treating atrial flutter wherein the tip of the lead is fixed in the patient's heart by screwing and wherein the electrodes are arranged on the lead so as to overlie the area between the tricuspid annulus and the inferior vena cava. Radiofrequency energy is applied through the electrodes to cause ablation of the tissue. With the tips screwed in position, the lead can then be manipulated so that the RF energy can be applied to the area between the coronary sinus the tricuspid annulus to cause ablation of the tissue in that area also. Excerpt(s): The present invention relates to a method and system for treating atrial flutter. Atrial flutter is a common rhythm disturbance defined as an atrial tachycardia with atrial rates exceeding 240 beats per minute. Most methods of treating atrial flutter involve pacing the heart using an appropriate pacing rate. Web site: http://www.delphion.com/details?pn=US06443950__

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Atrial flutter cardioverter and method Inventor(s): Adams; John M. (Issaquah, WA), Ayers; Gregory M. (Redmond, WA) Assignee(s): InControl, Inc. (Redmond, WA) Patent Number: 5,814,081 Date filed: April 7, 1997 Abstract: An implantable atrial defibrillator includes a lead system having a plurality of electrodes to deliver a cardioverting pulse to atria of a heart, for sensing A waves of the heart, and for sensing R waves of the heart. A first detector detects the A waves sensed by the lead system and a second detector detects the R waves sensed by the lead system. An inhibit stage defines an inhibit time period responsive to each detected R wave and an output provides the cardioverting pulse to the lead system responsive to an A wave being detected. The inhibit stage precludes provision of the cardioverting pulse during each inhibit time period. Excerpt(s): The present invention generally relates to an atrial cardioverter/defibrillator and method for applying cardioverting electrical energy to the atria of a human heart in need of cardioversion. The present invention is more particularly directed to an improved atrial cardioverter which cardioverts atrial flutter or other organized atrial tachyarrhythmia by applying a pulse of cardioverting electrical energy to the atria responsive to detection of an atrial activation and outside an inhibit interval timed from a detected R wave. Atrial fibrillation is probably the most common cardiac arrhythmia. Although it is not usually a life-threatening arrhythmia, it is associated with strokes thought to be caused by blood clots forming in areas of stagnant blood flow as a result of prolonged atrial fibrillation. In addition, patients afflicted with atrial fibrillation

Patents 63

generally experience rapid and irregular beating of the heart and may even experience dizziness as a result of reduced cardiac output. Atrial fibrillation occurs suddenly, and many times can only be corrected by discharging electrical energy into the atria of the heart of the patient. This treatment is preferably synchronized to a detected R wave of the heart in order to avoid shocking the atria during the T wave or vulnerable period of the heart. The amount of energy which may be required to successfully cardiovert the atria can be as low as one joule and as high as six joules. In most cases, energy of about two to four joules is required to cardiovert atrial fibrillation back to normal sinus rhythm (NSR). Web site: http://www.delphion.com/details?pn=US05814081__ •

Device for identifying atrial depolarization Inventor(s): Wecke; Liliane (Sundbyberg, SE) Assignee(s): Siemens-Elema AB (Solna, SE) Patent Number: 5,400,796 Date filed: October 22, 1993 Abstract: A device for identifying an event, among atrial events sensed in a heart, as an atrial depolarization includes an atrial detector which emits a first signal when an event is sensed in the atrium, and a ventricular detector which emits a second signal when an event is sensed in the ventricle. A window generator creates a time window with the first signal inside the window, and a comparator determines whether the second signal is inside or outside the window. If the second signal is outside the window, an identification signal for the atrial depolarization is emitted. In subsequent circuits in the device, an event sensed in the atrium can be indicated as e.g. atrial flutter or a crosstalk QRS. The indications can be used for controlling a heart stimulator. A corresponding method is also disclosed. Excerpt(s): The present invention relates to a device and method for identifying an event, among events detected in the atrium in a heart, as an atrial depolarization. An atrial depolarization manifests itself as a P wave when cardiac activity is recorded in an ECG. The corresponding depolarization in the ventricle gives rise to a QRS complex or an R wave in the ECG. In, e.g., physiological studies or in the treatment of the heart with an electrical heart stimulator such as a defibrillator, pacemaker etc., reliable identification of an atrial depolarization among events sensed in the atrium is important in many cases. Reliable identification of the P wave is a problem, however, as illustrated below with an example from dual-chamber pacing. A dual chamber pacemaker can operate in different modes, usually designated with a three-position alphabetic code in which the first letter indicates stimulation in the atrium (A), ventricle (V) or both (D), the second letter indicates sensing in the atrium (A), ventricle (V) or both (D) and the third letter indicates the pacemaker's operating mode, i.e. triggered (T), inhibited (I) or both (D). For simplicity, these alphabetic designations will be used where appropriate in the description below, the letter A thus generally designating the atrium. Web site: http://www.delphion.com/details?pn=US05400796__

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Device for the transvenous cardioversion of atrial fibrillation or atrial flutter including three coil electrodes Inventor(s): Michel; Ulrich (Kaiserslautern, DD) Assignee(s): Cardiac Pacemakers, Inc. (St. Paul, MN) Patent Number: 5,913,887 Date filed: February 27, 1997 Abstract: A transvenous catheter for the cardioversion of atrial fibrillation or atrial flutter and/or the stimulation of the heart's activity. The catheter has an electrically active section within a heart and an electrically passive section carrying electrical cables. At least two defibrillation electrodes are located in the electrically active section and coupled to the electrical cables of the catheter. Additionally, there are at least one sensing ring electrode positioned between the at least two defibrillation electrodes and coupled to the electrical cables. Excerpt(s): The present invention relates generally to implantable medical devices and in particular to an implantable transvenous catheter as well as an analysis, pacemaker and/or defibrillation unit. A disorder having a rapid, irregular sequence of heart beats resulting from a disordered electrical excitation of the atria, is known as atrial fibrillation or atrial flutter. A distinction is made between paroxysmal (sudden) and persistent (chronic) arrhythmia. Some of these arrhythmia types may be treated by medications while others must be treated by external cardioversion. For this latter treatment, a high quantity of energy is output through the external area of the body, conventionally under anesthetic to restore the normal cardiac rhythm (sinus rhythm). Several studies have managed to show that the transvenous cardioversion of atrial fibrillation and/or atrial flutter can be performed with a considerably lower energy level than if the energy is applied to the external area of the body. The use of an energy quantity of 200 J in an initial phase of treatment for external cardioversion and, in the event of its failure, two further pulses of 360 J, is proposed by Gordon A. Ewy as the optimal form of therapy in his article entitled "Optimal Technique for Electrical Cardioversion of Atrial Fibrillation", Circulation, pp. 1645 ff, Volume 86, No. 5, November 1986. Despite these high levels of energy output, Ewy emphasizes that great care must be given to ensuring the correct positioning and low transfer resistance of the external defibrillation electrodes, to achieve the best results. Web site: http://www.delphion.com/details?pn=US05913887__

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Diagnosis and treatment of atrial flutter in the right atrium Inventor(s): Hassett; James A. (Bloomington, MN), Ockuly; John D. (Minnetonka, MN), Swartz; John F. (Tulsa, OK) Assignee(s): Daig Corporation (Minnetonka, MN) Patent Number: 5,846,223 Date filed: May 24, 1996 Abstract: A process for the treatment of atrial flutter and/or atrial fibrillation in the right atrium by use of an ablating and/or mapping catheters guided by a guiding introducer. Also disclosed is a predetermined shape for the guiding introducer for use in the treatment of atrial flutter and/or atrial fibrillation in the right atrium.

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Excerpt(s): This invention relates to introducers. More particularly, this invention relates to a guiding introducer for use within the right atrium of the human heart for the treatment of atrial flutter. Introducers and catheters have been in use for medical procedures for many years. For example, one use has been to convey an electrical stimulus to a selected location within the human body. Another use is to monitor and make measurements for diagnostic tests within the human body. Catheters may be used by a physician to examine, diagnose and treat while positioned at a specific location within the body which is otherwise inaccessible without more invasive procedures. In use, catheters may be inserted into a major vein or artery which is near the body surface. These catheters are then guided to the specific location for examination, diagnosis or treatment by manipulating the catheter through the artery or vein of the human body. Catheters have become increasingly useful in remote and difficult to reach locations within the body. However, the utilization of these catheters is frequently limited because of the need for the precise placement of the tip of the catheter at a specific location within the body. Web site: http://www.delphion.com/details?pn=US05846223__ •

Electrophysiological device for the isthmus Inventor(s): Chun; Sung (Palo Alto, CA), Hilario; Reynaldo P. (Mountain View, CA), Hill, III; E. Richard (Berkeley, CA), Huynh; Tim Ngeo (Santa Clara, CA), Obara; Robert (Fremont, CA), Seraj; Mahmoud R. (Mountain View, CA) Assignee(s): Cardima, Inc. (Fremont, CA) Patent Number: 6,746,446 Date filed: August 4, 2000 Abstract: An intravascular electrophysiology (EP) device for the mapping and/or formation of lesions along the isthmus region of a heart that has particular utility in the treatment of atrial flutter. The EP device of the invention has an elongated shaft with a proximal section, a compound-curved or modified pigtail-shaped distal section, and a plurality of at least partially exposed electrodes disposed on an outer surface of the distal section. The electrodes are spaced along a length of the distal section and may be interspersed with at least one temperature sensor located between electrodes. The shape of the distal end of the device enables manipulation of the device by inserting its distal end in the tricuspid valve and retracting the device to bias the section having electrodes along the isthmus to achieve acceptable contact with the region so high frequency (e.g., RF) electrical energy delivered to the electrodes on the distal section of the EP device will form a lesion. Sections of the isthmus where treatment is desired but not reached by the section of the device biased against tissue by retraction may be ablated by repeating the steps of hooking the tricuspid valve at a different end location of the device and retracting to bias the electrodes against different tissue, simply advancing the section with electrodes to the desired site or retracting the device so a tip connected to an RF source will drop into a desired site where ablation may occur. Excerpt(s): This relates to the elimination of cardiac arrhythmia, particularly, atrial flutter by interrupting signals crossing the so-called isthmus region of the heart through electrophysiological (EP) treatment. Cardiac arrhythmia presently affects approximately 2 million people in the United States alone. A first type of arrhythmia, atrial fibrillation, is the disorganized depolarization of a patient's atrium, with little or no effective atrial contraction. Various uncoordinated stages of depolarization and repolarization, due to multiple reentry circuits within the atria, cause, instead of intermittent contraction,

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quivering in a chaotic pattern that results in an irregular and often rapid ventricular rate. A second type, atrial flutter, is a condition in which atrial contractions are rapid (250 to 300 beats per minute), but regular. In many instances, a circus movement caused by reentry is probably present. The condition is such that the ventricles are unable to respond to each atrial impulse so that at least a partial atrioventricular block develops. Either condition may be chronic or intermittent. It is atrial flutter that the present invention is most intended to address. Prior methods for treating a patient's arrhythmia include the use of antiarrhythmic drugs such as sodium and calcium channel blockers or drugs which reduce the Beta-adrenergic activity. Other methods include surgically sectioning the origin of the signals causing the arrhythmia, or the conducting pathway for such signals. However, the surgical technique is quite traumatic and is unacceptable to a large number of patients. A more frequently used technique to terminate the arrhythmia involves destroying the heart tissue which causes the arrhythmia by heat, e.g., applying a laser beam or high frequency electrical energy, such as RF or microwave, to a desired arrhythmogenic site on the patient's endocardium. In the latter method, intravascular (EP) devices can be used to form contiguous lesions within a patient's atrial chamber to provide results similar to the surgical segregation techniques in terminating the arrhythmia but with significantly reduced trauma. Web site: http://www.delphion.com/details?pn=US06746446__ •

Flexible recording/high energy electrode catheter with anchor for ablation of atrial flutter by radio frequency energy Inventor(s): Gurley; John C. (Lexington, KY), Kuo; Chien-Suu (Lexington, KY) Assignee(s): University of Kentucky Research Foundation (Lexington, KY) Patent Number: 6,623,480 Date filed: July 23, 1999 Abstract: An electrode catheter is provided having a predetermined flexibility throughout the entire length or at least at the contact portion, such as the electrode region, to allow for the molding of the contact portion such that it conforms to the shape of the heart at a preselected desired target area, such as the isthmus between the inlet of inferior vena cava and posterior tricuspid annulus. The catheter also includes a guiding sheath that is preferably semirigid and may be pre-shaped with at least one bend or angulation to assist in molding to ensure that the electrode region overlies the desired target treatment area. A remotely controlled anchoring device is provided at the distal end of the catheter for anchoring it in position to facilitate the molding operation and placement over the target treatment area. A method of cardiac ablation using the catheter of the present invention is also disclosed. Excerpt(s): The present invention relates to the field of interventional cardiology and, more particularly, to a catheter and a related method for the ablation of atrial flutter utilizing radio frequency energy. Many advances have been made in interventional therapy for cardiac arrhythmias, as devices such as catheters for mapping and ablation of target areas have improved. Many arrhythmias are now frequently treated by using specially adapted radio frequency (RF) catheters. The successful treatment rate of RF catheters may reach >90% for certain cardiac arrhythmias. Moreover, RF ablation using a catheter does not require general anesthesia and recovery from the procedure is rapid. Electrical conduction problems such as ventricular tachycardia and artioventricular node reentrant tachycardia are also routinely treated without general anesthesia utilizing radio frequency ablation. However, for those patients in whom maintenance of

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sinus rhythm is not possible (approximately 20% of patients over 60 years old), control of ventricular rate is achieved with AV nodal blockers such as digoxin,.beta.-blockers, or calcium channel blockers. Although prior to the present invention, a "cure" of atrial fibrillation with catheter ablation techniques appeared not to be possible, various attempts had been made at permanent modification of the AV conduction such that rapid conduction could be eliminated, but normal conduction (fewer than 100 beats per minute) remains, thereby avoiding the need for a permanent pacemaker. Unfortunately, these attempts have been unsuccessful. See, Vogel & King, The Practice of Interventional Cardiology, 2.sup.nd Ed., pages 671-683 (1993). Web site: http://www.delphion.com/details?pn=US06623480__ •

Indanyl-substituted benzenecarboxamides, processes for their preparation, their use as a medicament, and pharmaceutical formulations containing them Inventor(s): Brendel; Joachim (Bad Vilbel, DE), Gerlach; Uwe (Hattersheim, DE), Lang; Hans-Jochen (Hofheim, DE), Stilz; Hans Ulrich (Frankfurt, DE) Assignee(s): Aventis Pharma Deutschland GmbH (Frankfurt am Main, DE) Patent Number: 6,221,866 Date filed: June 23, 2000 Abstract: in which R(1) to R(8) have the meanings stated in the claims, act on the Kv1.5 potassium channel, and inhibit a potassium current, referred to as "ultra-rapidly activating delayed rectifier," in the human atrium. They are therefore very particularly suitable as novel antiarrhythmic active substances, in particular for the treatment and prophylaxis of atrial arrhythmias, e.g., atrial fibrillation or atrial flutter. Excerpt(s): and in which R(1), R(2), R(3), R(4), R(5), R(6), R(7), R(9), R(10), R(11), R(12), R(13), R(14), and R(15) have the meanings stated below, their preparation, and their use, in particular in medicaments. Compounds according to the invention act on the socalled Kv1.5 potassium channel and inhibit a potassium current, referred to as "ultrarapidly activating delayed rectifier," in the human atrium. The compounds are therefore very particularly suitable as novel antiarrhythmic active substances, in particular for the treatment and prophylaxis of atrial arrhythmias, e.g., atrial fibrillation or atrial flutter. Atrial fibrillation (AF) and atrial flutter are the most frequent persistent cardiac arrhythmias. They occur increasingly with increasing age and frequently lead to fatal consequences, such as, for example, a cerebrovascular accident. AF affects about 1 million Americans annually and leads to more than 80,000 strokes every year in the USA. The class I and III antiarrhythmic drugs commonly used at present reduce the rate of recurrence of AF but, owing to their potential proarrhythmic side effects, are used only to a limited extent. There is therefore a considerable medical necessity for the development of better medicaments for the treatment of atrial arrhythmias (S. Nattel, "Newer developments in the management of atrial fibrillation," Am. Heart J. 130 (1995;) 1094-1106). Web site: http://www.delphion.com/details?pn=US06221866__

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Method and system for the treatment of hyperkinetic atrial arrhythmia Inventor(s): Del Giglio; Mauro (Villaggio Santa Barbara 394, I-52022 Cavriglia (Arezzo) Assignee(s): none reported Patent Number: 6,416,493 Date filed: June 27, 1997 Abstract: A method and device for the pharmacological cardioversion of fibrillation or atrial flutter is disclosed. The device is implantable in the human body and provides equipment for drug infusion using an electrocatheter positioned in the right atrium, the right ventricle, or the coronary sinus. The electrocatheter is provided with sensors which monitor the electromechanical activity of the heart and which intervene to activate the infusion in the presence of fibrillation or flutter. The catheter may be provided with at least one balloon which can be inflated and deflated to create a chamber which permits perfusion of the drug directly into the vein of Marshall. Excerpt(s): This invention is in the field of implantable medical devices. More particularly, the invention is in the field of implantable devices for the detection and interruption of hyperkinetic atrial arrhythmia. Hyperkinetic atrial arrhythmia includes a large number of generally benign disorders characterised by an increase in the frequency of atrial contraction, possibly accompanied by an increase in frequency of ventricular contraction. These increases can lead to fibrillation and flutter in which the movement of the atrium is chaotic and does not correspond to that of the ventricle. Clinical electrocardiograms may suggest the following risks for the patient: atrial tachycardia (from 140 to 220 bpm) caused by heart disease which can result in a net reduction in the cardiac output due to reduced atrial and ventricular filling in combination with hypotension and lipothymia; atrio-ventricular junctional tachycardia with feedback of the P wave and a reduction in cardiac output; multiform supraventricular tachycardia from different atrial pacemakers functioning separately, with extreme variability of cardiac frequency; atrial flutter, in which the frequency of atrial contraction is more than 200 bpm, with a variable ventricular response depending on the conduction ratio (2:1, 3:1 etc.); and atrial fibrillation, comprising a chaotic movement of the atria which become distended and do not empty properly. Web site: http://www.delphion.com/details?pn=US06416493__

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Method of using spectral measures to distinguish among atrialfibrillation, atrialflutter and other cardiac rhythms Inventor(s): Reddy; Shankara (Cedarburg, WI), Taha; Basel (Menomonee Falls, WI), Xue; Joel (Germantown, WI) Assignee(s): GE Medical Systems Information Technologies, Inc. (Milwaukee, WI) Patent Number: 6,597,943 Date filed: December 26, 2000 Abstract: A method and apparatus are provided for differentiating among atrial-flutter, atrial-fibrillation and other cardiac rhythms. The method includes the steps of estimating a spectral entropy of atrial cardiac activity from an electrocardiogram of a patient and determining that the patient has atrial fibrillation when the spectral entropy is greater than a predetermined value.

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Excerpt(s): The field of the invention relates to cardiac monitoring and more particularly to methods of distinguishing between different types of cardiac abnormalities. Atrial fibrillation (AFIB) and atrial flutter (AFL) are two of the most common abnormal cardiac rhythms, constituting up to 8% of electrocardiograms (ECGs) collected by hospitals. The two rhythms have clinically different implications and require different management. In addition, fibrillatory and flutter waves have different generating mechanisms in the atria. However, these two rhythms are often cross classified by physicians and by computerized ECG analysis systems for two main reasons. First, patterns of atrial flutter and fibrillation often coexist within the same ECG segment examined. The second cause of cross-classification is due to the difficulty of detecting atrial activity (visually or by computer time-based analysis) due to the overlying (and dominant) waveforms of ventricular origin (i.e., the QRS complex and T-wave), especially in the case of high ventricular rates. Web site: http://www.delphion.com/details?pn=US06597943__ •

System and method for developing a database of body surface ECG flutter wave data maps for classification of atrial flutter Inventor(s): Groenewegen; Arne Sippens (Burlingame, CA) Assignee(s): The Regents of the University of California (Oakland, CA) Patent Number: 6,556,860 Date filed: November 28, 2000 Abstract: A method and apparatus for developing a database of mean body surface ECG flutter wave data maps for classification of atrial flutter are described. ECG signals from a plurality of torso sites and multisite endocardial recordings are obtained during CCW and CW typical atrial flutter and atypical atrial flutter. Flutter wave episodes are divided into two or three successive time intervals showing stable potential distributions from which data maps are computed. Body surface mapping of CCW and CW typical atrial flutter and atypical atrial flutter is compared with endocardial activation sequence mapping to confirm validity between the body surface ECG pattern and the underlying right or left atrial activation sequence. The body surface ECG map patterns of CCW and CW typical atrial flutter are characterized by a stereotypical spatial voltage distribution that can be directly related to the underlying activation sequence and are highly specific to the direction of flutter wave rotation. The mean body surface ECG flutter wave data maps present a unique reference database for improved clinical detection and classification of typical and atypical atrial flutter. Excerpt(s): This invention relates generally to a method for classification of atrial arrhythmias. More particularly, it relates to a system for developing a database of body surface ECG flutter wave maps for the classification of the type and rotation of atrial flutter. Clinical electrocardiography of counterclockwise (CCW) typical atrial flutter (also known as common or type I atrial flutter) dates back to the early part of the 20.sup.th century. The continuous or "sawtooth" pattern of the flutter wave in standard ECG leads II and III was first reported and attributed to an atrial impulse circulating around both caval veins. Later reports provided further evidence to the concept of an excitation wave rotating in a CCW direction in the right atrium and giving rise to the distinct "sawtooth" pattern with predominantly negative flutter waves in the inferior leads and V.sub.6 combined with a positive flutter wave in V.sub.1. With the introduction of multisite endocardial mapping, entrainment techniques, and catheter ablative strategies in the therapeutic management of the typical form of atrial flutter,

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flutter wave propagation has been convincingly demonstrated to occur in a macroreentrant right atrial circuit confined anteriorly by the tricuspid annulus and posteriorly by the crista terminalis and its inferior extension the eustachian ridge, which act as natural barriers to conduction. In addition to CCW rotation of the flutter wave, it has been shown that clockwise (CW) impulse rotation in the same right atrial circuit can be frequently observed. Although there is general consensus on the previously mentioned distinct morphology of the standard 12-lead electrocardiogram (ECG) during CCW typical atrial flutter, ECG features found to be most specific for CW typical atrial flutter are more variable. Visual assessment of the flutter wave polarity on the standard 12-lead ECG is hampered by low voltage, a continuously undulating signal, and QRST wave obscurement when a low degree of atrioventricular (AV) block is present. Moreover, the standard 12-lead ECG has been found insufficient in distinguishing between CCW and CW typical atrial flutter or between the two forms of typical and atypical atrial flutter. Consequently, electrocardiographic determination of the type (typical or atypical) and rotation (CCW or CW for typical) of atrial flutter is often hampered by inaccurate and inconclusive scalar waveform analysis of the standard 12lead ECG. This may then require more invasive techniques being employed to obtain further information or a misdiagnosis may occur, both of which increase patient risk and expense. Such additional information may be needed to select an appropriate therapy, e.g., radiofrequency catheter ablation, or anti-arrhythmic drugs. Web site: http://www.delphion.com/details?pn=US06556860__ •

Use of autonomic nervous system neurotransmitters inhibition and atrial parasympathetic fibers ablation for the treatment of atrial arrhythmias and to preserve drug effects Inventor(s): Rahme; Marc Mounir (5128 Bowden Ave., San Diego, CA 92117) Assignee(s): none reported Patent Number: 6,511,500 Date filed: June 6, 2000 Abstract: Atrial arrhythmias, a major contributor to cardiovascular morbidity, are believed to be influenced by autonomic nervous system tone. The main purpose of this invention was to highlight new findings that have emerged in the study of effects of autonomic nervous system tone on atrial arrhythmias, and its interaction with class III antiarrhythmic drug effects. This invention evaluates the significance of sympathetic and parasympathetic activation by determining the effects of autonomic nervous system using a vagal and stellar ganglions stimulation, and by using autonomic nervous system neurotransmitters infusion (norepinephrine, acetylcholine). This invention evaluates the autonomic nervous system effects on the atrial effective refractory period duration and dispersion, atrial conduction velocity, atrial wavelength duration, excitable gap duration during a stable circuit (such atrial flutter circuit around an anatomical obstacle), and on the susceptibility of occurrence (initiation, maintenance and termination) of atrial reentrant arrhythmias in canine. This invention also evaluates whether autonomic nervous system activation effects via a local neurotransimitters infusion into the right atria can alter those of class III antiarrhythmic drug, sotalol, during a sustained right atrial flutter. This invention represents an emergent need to set-up and develop a new class of anti-cholinergic drug therapy for the treatment of atrial arrhythmias and to combine this new anti-cholinergic class to antiarrhythmic drugs. Furthermore, this invention also highlights the importance of a local application of parasympathetic

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neurotransmitters/blockers and a catheter ablation of the area of right atrium with the highest density of parasympathetic fibers innervation. This may significantly reduce the occurrence of atrial arrhythmias and may preserve the antiarrhythmic effects of any drugs used for the treatment of atrial re-entrant arrhythmias. Excerpt(s): Cardiac rhythm disturbances are a major cause of morbidity and even mortality in our ageing population. Most of these rhythms are based on reentry, i.e. the continuous circulation of a wavefront of excitation around a functional or anatomical circuit such atrial fibrillation and flutter. Atrial fibrillation could exist as a stable state, self-sustained and independent of its initiating trigger in the presence of non-uniform distribution (i.e. dispersion) of atrial refractory periods. In addition, maintenance of atrial fibrillation may require a critically short wavelength in order to sustain reentry. However, the cellular and pathophysiological mechanisms in the initiation and maintenance of atrial fibrillation remain poorly understood. It has been reported that inducibility and maintenance of this atrial arrhythmia are associated with an increased dispersion in atrial refractoriness. In addition, alterations in the electrophysiologic properties of the atria affecting wavelength may led to persistence of atrial fibrillation and to the occurrence of reentrant atrial arrhythmias in both in vitro and in vivo models. Furthermore, electrical remodeling of the atria may also increase the likelihood to the maintenance of this atrial arrhythmia. Electrophysiological studies suggest that the mechanism of type I atrial flutter in humans and in canine models involves a macroreentrant circuit around an anatomically or anisotropically defined obstacle with either a partially or fully excitable gap. The excitable gap is one of the determinant of the continued circulation of the abnormal atrial impulse and in its presence an extrastimulus may excite the circuit and reset the tachycardia. Furthermore, the persistent circulation of this wavefront is determined by the effective refractory period, the conduction velocity, the wavefront and the nature and duration of the excitable gap, i.e. that portion of the circuit which has partially or fully recovered its excitability. This excitable gap, in part, determined by the size of the reentry circuit and the electrophysiological properties of its tissue components. However, external influences may also significantly modify the susceptibility for the occurrence of atrial arrhythmias via different electrophysiological mechanisms such as the excitable gap characteristics, the effective refractory period duration and dispersion, the conduction velocity, the wavefront duration and propagation forms and the number of the wavelets. Autonomic nervous system tone may implicitly have a role in the pathogenesis of initiation and persistence of supraventricular arrhythmias. In experimental models, both vagal stimulation and acetylcholine application to the heart can nonhomogeneously shorten atrial refractory period and produce either paroxysmal atrial arrhythmia, flutter or fibrillation. In man, the onset of atrial fibrillation has a diurnal distribution with a statistically significant peak occurring at night which correlates with an immediately preceding increase in vagal drive. Catecholamine administration (Isoproterenol) also shortens the atrial action potential and stimulation of sympathetic nerves shortens atrial refractoriness and increases its dispersion facilitating the induction of atrial fibrillation. In man, attacks of atrial fibrillation have also been reported to be associated with adrenergic activation. Little is known, however, on the possible influence of autonomic nervous system tone on an established stable reentry circuit such as is seen in atrial flutter, an arrhythmia which is frequently difficult to interrupt by pharmacological means, and also on the occurrence of the leading circle phenomena during atrial fibrillation episodes. In a human study of parasympathetic and sympathetic blockade, observations limited to effects on atrial flutter cycle length did not detect any change either in the supine or upright position. No study has yet addressed the effects of

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autonomic neurotransmitters on the refractory period, duration and composition of the excitable gap and thus, on the viability of an atrial reentry circuit. Web site: http://www.delphion.com/details?pn=US06511500__ •

Waveform morphology discriminator and method Inventor(s): Hartlaub; Jerome T. (New Brighton, MN) Assignee(s): Medtronic, Inc. (Minneapolis, MN) Patent Number: 4,552,154 Date filed: March 12, 1984 Abstract: A waveform detection system for use in a pacemaker for distinguishing normal beats from ectopic or abnormal beats for example, such as those involving ventricular tachycardia, ventricular flutter or fribrillation, premature ventricular beats, supraventricular tachycardia, retrograde conduction; and in dual chamber or atrial applications those involving atrial tachycardia and atrial flutter or fibrillation. The term "abnormal" is employed herein to mean all abnormal beats including those specified above. In the system of the illustrated embodiment a sense amplifier is employed for initiating a counter in response to a detected cardiac event and a voltage controlled oscillator is used for converting the instantaneous value of the applied waveform to a bit rate delivered to the counter. The morphology or shape of the physiological waveform is represented by a number present in the counter at the end of the counting cycle which allows for a therapy decision to be made. Excerpt(s): This invention relates to implanted medical devices and, more particularly relates to a physiological waveform morphology discriminator and method for use in a pacemaker for characterizing the origin of cardiac depolarizations. A variety of disease mechanisms may result in cardiac dysrhythmias. Typically these dysrhythmias are characterized by electrical instability in the cardiac tissue which results in abnormal mechanical activity of the heart. The abnormal mechanical activity results in the reduction of the rate at which oxygenated blood is circulated throughout the body. The parameter is called cardiac output. If the loss of cardiac output results from a heartbeat slower than a normal heartbeat responding to the same physiologic demand, the dysrhythmia is called a bradycardia. In contrast, an abnormally rapid beating of the heart which also results in reduced cardiac output is generically termed a pathologic tachycardia. Pacers for the treatment of bradycardia are known from U.S. Pat. No. 3,478,746 to Greatbatch. This patent teaches a demand type (VVI) pacemaker which provides a stimulus to cardiac tissue through a pacing lead; if no naturally occurring cardiac activity is sensed within a preset time period referred to as the escape interval. Consequently, the stimulating pulses are supplied to the heart only when the intrinsic heart rate drops below a preset minimum corresponding to this escape interval. Web site: http://www.delphion.com/details?pn=US04552154__

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Patent Applications on Atrial Flutter As of December 2000, U.S. patent applications are open to public viewing.6 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to atrial flutter: •

Anthranilamides and methods of their use Inventor(s): Brendel, Joachim; (Bad Vilbel, DE), Hemmerle, Horst; (Indianapolis, IN), Kleemann, Heinz-Werner; (Bischofsheim, DE), Peukert, Stefan; (Frankfurt, DE), Pirard, Bernard; (Frankfurt, DE) Correspondence: Finnegan, Henderson, Farabow,; Garrett & Dunner, L.L.P.; 1300 I Street, N.W.; Washington; DC; 20005-3315; US Patent Application Number: 20030187033 Date filed: April 26, 2002 Abstract: The present invention is related to anthranilamides of formula I, 1in which R(1) to R(7) have the meanings indicated herein, a process for their preparation, their use as medicaments, and pharmaceutical preparations containing them. The compounds act on the Kv1.5 potassium channel and inhibit a potassium current which is referred to as the ultra-rapidly activating delayed rectifier in the atrium of the human heart. The compounds are therefore suitable for use as novel antiarrhythmic agents for the treatment and prophylaxis of atrial arrhythmias (e.g., atrial fibrillation (AF) or atrial flutter). Excerpt(s): in which R(1), R(2), R(3), R(4), R(5), R(6) and R(7) have the meanings indicated hereinafter, to their preparation and use, and in particular, to their use as pharmaceuticals. The compounds of formula I have not previously been disclosed. They act on the Kv1.5 potassium channel in the atrium of the human heart, which is referred to as ultra-rapidly activating delayed rectifier, and inhibit the potassium current. The compounds are therefore suitable as novel antiarrhythmic agents for the treatment and prophylaxis of atrial arrhythmias, e.g., atrial fibrillation (AF) or atrial flutter. Atrial fibrillation (AF) and atrial flutter are the most common and persistent cardiac arrhythmias. Their occurrence increases with increasing age and frequently leads to other fatal symptoms, such as stroke. AF affects about 1 million Americans each year and leads to more than 80,000 strokes annually in the USA. The class I and III antiarrhythmic agents in use at present reduce the rate of AF occurrence, but can only be used in a limited manner due to their proarrhythmic side effects. Consequently, there is a great medical need to develop better medicaments for the treatment of atrial arrhythmias (S. Nattel (1995) "Newer developments in the management of atrial fibrillation," Am. Heart J., 130:1094-1106). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

6

This has been a common practice outside the United States prior to December 2000.

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Bayesian discriminator for rapidly detecting arrhythmias Inventor(s): Chan, Francis Hy; (Pokfulam, HK), Fung, Peter Chin Wan; (Pokfulam, HK), Lau, Chu-pak; (Midlevel, HK), Tse, Hung-Fat; (Midlevel, HK), Xu, Weichao; (Shenzhen, CN) Correspondence: Pennie And Edmonds; 1155 Avenue OF The Americas; New York; NY; 100362711 Patent Application Number: 20030216654 Date filed: May 7, 2002 Abstract: A method for accurate and rapid automated detection of atrial fibrillation (AF), sinus rhythm (SF), and atrial flutter (AFL) is disclosed, which allows distinguishing of these cardiac signals with lowered risk of errors by implanted pacemakers and like devices. The method includes training episodes of intra-cardiac signals (called the closed data set CDS) to evaluate five feature parameters with a discriminator classifying the signal into AF, AFL or sinus rhythm (SR). Comparison with the independent decisions of experienced physicians for each episode reveals specificity, accuracy and sensitivity of greater than 97%. Each episode is a window of intracardiac signal of interval 1-2 seconds with the discriminator providing results in less than 0.25 s. In another aspect, the method is resistant to the presence of noise in the data. In yet another aspect, more feature parameters may be used in alternative implementations including for detecting signals other than AF, AFL & SR. Excerpt(s): The invention is directed to the generation and analysis of data with a multiple-index Bayesian discriminator. More specifically, the invention is directed to methods, systems, and devices for detecting and treating arrhythmias and heart diseases. Arrhythmias are caused by a disruption of the normal electrical conduction system of the heart, causing abnormal heart rhythms. Normally, the four chambers of the heart (2 atria and 2 ventricles) contract in a very specific, coordinated manner. The signal to contract is an electrical impulse that begins in the "sinoatrial node" (the SA node), which is the body's natural pacemaker. The signal then travels through the two atria and stimulates them to contract. The signal passes through the "atrioventricular note" node (the AV node), and finally travels through the ventricles and stimulates them to contract. Problems can occur anywhere along the electrical conduction system, causing various arrhythmias. There can be a problem in the heart muscle itself, causing it to respond differently to the signal, or causing the ventricles to contract out of step with the normal conduction system. Other causes of arrhythmias include abnormal rhythmicity of the body's natural pacemaker, a shift of the pacemaker from SA node to other parts, blocks at different transmission points, abnormal pathways of impulse conduction, and spontaneous general of abnormal impulses due to ischemia (low flow to coronary arteries), hypoxia (low oxygen), ANS imbalance, lactic acidosis, electrolyte abnormality, drug toxicity, and hemodynamic abnormalities. Atrial fibrillation (AF) is the most common form of supraventricular arrhythmia and is associated with a considerable risk of morbidity and mortality. (Benjamin E J, et al., 1998 Circulation 98:946-952; Ryder K M, et al., 1999 Am J Cardiol. 84:1311R-138R; Chugh S S, et al. 2001 J Am Coll Cardiol. 37:371-377). As many as 2 million Americans are living with atrial fibrillation according to the American Heart Association. Theoretical analyses and highdensity mapping studies have suggested that the most common mechanism of AF is the presence of multiple wave fronts or "wavelets" circulating irregularly throughout the atrial tissue. (Moe G K, et al., 1964 Am Heart J. 67:2961-2967; Allessie M A, et al., "Experimental Evaluation of Moe s Multiple Wavelet Hypothesis of Atrial Fibrillation" in Zipes E P, Jalife J, eds. Cardiac Electrophysiology and Arrhyhtmias. Orlando, Fla:

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Grune & Stratton, Inc., 1985; pp 265-275; Konings KTS, et al., 1994 Circulation 89:16651680). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Cardiac magnetic field diagnozer for atrial flutter and atrial fibrillation and method for identifying electric turning path of atrial flutter and atrial fibrillation Inventor(s): Fujita, Satoshi; (Osaka, JP), Kawazoe, Kohei; (Iwate, JP), Nakai, Kenji; (Iwate, JP), Tamura, Itsuro; (Osaka, JP), Yamazaki, Keita; (Chiba, JP), Yoshizawa, Masahito; (Iwate, JP) Correspondence: Birch Stewart Kolasch & Birch; PO Box 747; Falls Church; VA; 220400747; US Patent Application Number: 20040077964 Date filed: October 14, 2003 Abstract: A magnetic field distribution measurement device (1) provides a non-contact magnetic field measurement on a subject's chest at a plurality of coordinates and forms therefrom time-series magnetic field distribution data. A first arithmetic device (2) in response generates image data representing a three-dimensional, intramyocardial current density distribution. A second arithmetic device (3) receives a plurality of tomographic image data separately obtained by a tomographic diagnosis apparatus and processes the data to generate three-dimensional, anatomical image data. A display device (4) receives these data and displays on an anatomical image an image representing an intramyocardial current density. This can facilitate identifying an anatomical, positional relationship of an abnormal, electrical reentry circuit caused in heart muscle. Furthermore, the anatomical image may be replaced with an image representing a normal stimulation propagation circuit and serving as a template. Excerpt(s): The present invention relates generally to magnetocardiographic diagnosis apparatuses and methods of identifying an electrical reentry circuit, and particularly to those employing non-contact magnetic field measurement to non-invasively diagnose a three-dimensional location of an abnormal, intramyocardial excitation propagation circuit causing atrial flutter and fibrillation. Conventionally, recording electrocardiograms has been generally adopted as a technique to diagnose heart diseases. However, conventional electrocardiography is insufficient for example to determine the location, size and geometry of a part to be treated in a heart surgery and it cannot satisfactorily locate an affected part. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Compositions and methods for performing reverse gene therapy Inventor(s): Burton, Denise Y.; (Bensalem, PA), Levy, Robert J.; (Merion Station, PA) Correspondence: Dann, Dorfman, Herrell & Skillman; 1601 Market Street; Suite 2400; Philadelphia; PA; 19103-2307; US Patent Application Number: 20040087528 Date filed: July 31, 2003 Abstract: The invention relates to compositions and methods for reverse gene therapy, wherein a gene therapy vector encoding a gene product (e.g. a protein) which is usually

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only expressed in cells of an abnormal tissue is delivered to a cell of an animal afflicted with a disease or disorder to alleviate the disease or disorder. In one embodiment, a plasmid vector encoding HERG (A561V) protein is delivered to a cell of an animal afflicted with re-entrant atrial flutter-mediated cardiac arrhythmia. Excerpt(s): This application is a continuation-in-part application of U.S. patent application Ser. No. 09/487,851, filed Jan. 19, 2000, and also claims priority to U.S. Provisional 60/374,840 filed Apr. 24, 2002, the entire disclosures of each being incorporated by reference herein. The present invention relates to the fields of medicine and gene therapy. More specifically, the present invention relates to an adaptation of gene therapy to the field of tissue engineering. In particular, the invention concerns the use of cells that can generate tissue in vivo ("progenitor cells") as the means for effecting so-called reverse gene therapy (RGT), an approach generally described in PCT application WO 200041731 A1. Re-entrant atrial flutter is a disease condition which affects many individuals. Electrophysiologic mapping techniques have lead to an enhanced understanding re-entrant atrial arrhythmias, and these advances have led to attempts to develop ablation procedures which destructively block conduction in myocardial regions involved in re-entry (Natale et al., 1996, Am. J. Cardiol. 78:1431-1433; Frame et al., 1996, Pacing Clin. Electrophysiol. 19:965-975; Cosio et al., 1996, Arch. Mal. Coeur Vaiss. 1:75-81; Cox et al., 1995, J. Thorac. Cardiovasc. Surg. 110:485-495; Cox et al., 1993, Ann. Thorac. Surg. 56:814-823; Cox et al., 1996, J. Thorac. Cardiovasc. Surg. 112:898-907). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Device for the transvenous cardioversion of atrial fibrillation or atrial flutter Inventor(s): Michel, Ulrich; (Kaiserslautern, DE) Correspondence: Schwegman, Lundberg, Woessner & Kluth, P.A.; P.O. Box 2938; Minneapolis; MN; 55402; US Patent Application Number: 20020042631 Date filed: December 3, 2001 Abstract: A transvenous catheter for the cardioversion of atrial fibrillation or atrial flutter and/or the stimulation of the heart's activity. The catheter has an electrically active section within a heart and an electrically passive section carrying electrical cables. At least two defibrillation electrodes are located in the electrically active section and coupled to the electrical cables of the catheter. Additionally, there are at least one sensing ring electrode positioned between the at least two defibrillation electrodes and coupled to the electrical cables. Excerpt(s): This application is a continuation of U.S. patent application Ser. No. 09/528,680, filed on Mar. 20, 2000, which is a division of U.S. patent application Ser. No. 09/328,336, filed on Jun. 9, 1999, now issued as U.S. Pat. No. 6,041,256, which is a continuation of U.S. patent application Ser. No. 08/807,519, filed on Feb. 27, 1997, now issued as U.S. Pat. No. 5,913,887, the specifications of which are incorporated herein by reference. The present invention relates generally to implantable medical devices and in particular to an implantable transvenous catheter as well as an analysis, pacemaker and/or defibrillation unit. A disorder having a rapid, irregular sequence of heart beats resulting from a disordered electrical excitation of the atria, is known as atrial fibrillation or atrial flutter. A distinction is made between paroxysmal (sudden) and persistent (chronic) arrhythmia. Some of these arrhythmia types may be treated by medications

Patents 77

while others must be treated by external cardioversion. For this latter treatment, a high quantity of energy is output through the external area of the body, conventionally under anesthetic to restore the normal cardiac rhythm (sinus rhythm). Several studies have managed to show that the transvenous cardioversion of atrial fibrillation and/or atrial flutter can be performed with a considerably lower energy level than if the energy is applied to the external area of the body. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Highly specific technique for discriminating atrial fibrillation from atrial flutter Inventor(s): Lovett, Eric G.; (Roseville, MN) Correspondence: Schwegman, Lundberg, Woessner & Kluth, P.A.; P.O. Box 2938; Minneapolis; MN; 55402; US Patent Application Number: 20020193838 Date filed: August 13, 2002 Abstract: A cardiac rhythm management system including a highly sensitive technique for discriminating AF from AFL. An electrode disposed in or about a heart senses a cardiac signal. A controller through a sensing circuit receives the sensed cardiac signal from the electrode and processes the sensed cardiac signal to compute an average cycle length-to-cycle length variation based on serial interval relationships from the sensed cardiac signal, and then comparing the computed average cycle length-to-cycle length variation to one or more pre-determined threshold values to discriminate AF from AFL. As a result of substantial difference in cycle length-to-cycle length variation between AF and AFL (despite similar average cycle lengths), the sequence-based measure of cycle length-to-cycle length variability proves to be a highly specific and reliable discriminator of AF from AFL. Excerpt(s): This patent application is a division of U.S. patent application Ser. No. 09/548,981, filed on Apr. 14, 2000, the specification of which is incorporated herein by reference in its entirety. This invention relates generally to cardiac rhythm management systems, and particularly, but not by way of limitation, to a system for detecting atrial fibrillation and for discriminating atrial fibrillation from atrial flutter. When functioning properly, the human heart maintains its own intrinsic rhythm, and is capable of pumping adequate blood throughout the body's circulatory system. The body's autonomic nervous system regulates intrinsic electrical heart activity signals that are conducted to atrial and ventricular heart chambers on the left and right sides of the heart. The electrical heart activity signals trigger resulting heart contractions that pump blood. However, some people have irregular cardiac rhythms, referred to as arrhythmias. Some of the most common arrhythmias are atrial fibrillation (AF) and atrial flutter (AFL). Atrial fibrillation can result in significant patient discomfort and even death because of number of associated problems, including: (1) an irregular heart rate which causes the patient discomfort and anxiety, (2) loss of synchronous atrioventricular contractions which interferes with cardiac hemodynamics, resulting in varying levels of congestive heart failure, and (3) stasis of blood flow, which increases the vulnerability to thromboembolism. AF most commonly exhibit heartbeat rates of about 400 to 600 per minute in humans. On the other hand AFL is characterized by approximately 250 to 300 beats per minute. AFL is thought to result from a counterclockwise reentry circuit in the right atrium associated with the atrial septum and the right atrial freewall. The reentry circuit normally travels between the inferior

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vena cava and the tricuspid valve. Overlap between the ranges of number of beats per minute in AF and AFL is not uncommon. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and apparatus for displaying information retrieved from an implanted medical device Inventor(s): Blowers, Paul; (St. Paul, MN), Dirnberger, Denise; (Blaine, MN), Jamar, Pamela; (Plymouth, MN), Ousdigian, Kevin T.; (St. Paul, MN), Stone, Karen A.; (White Bear Lake, MN), Webb, James D.; (Maple Grove, MN) Correspondence: Girma Wolde-Michael; Medtronic, INC., MS 301; 7000 Central Avenue NE; Minneapolis; MN; 55432; US Patent Application Number: 20020077561 Date filed: December 14, 2000 Abstract: A graphical user interface is provided controllably displaying information retrieved from an implantable device, such as a pacemaker. The graphical user interface is comprised of a first and second window. The first window is adapted to display data identifying a plurality of episodes recorded by the implantable device, wherein the data is comprised of a plurality of fields. One of the fields may be used to identify a type of episode, such as ventricular tachycardia (VT), atrial and ventricular tachycardia (A&V), atrial fibrillation (AF), atrial flutter (Afl), atrial tachycardia (AT), and premature atrial contraction (PAC). The second window is adapted to display data types, such as VT, A&V, AF, Afl, AT, and PAC, that may be present in the plurality of fields, wherein at least one of the data types may be selected to filter the episodes displayed in the first window and display those episodes having the selected data types. Excerpt(s): This invention relates generally to a method and apparatus for displaying data, and, more particularly, to a method and apparatus for displaying data related to cardiac episodes, which have been recorded by an implanted medical device. Since the introduction of the first implantable pacemakers in the 1960s, there have been considerable advancements in both the field of electronics and medicine, such that there is presently a wide assortment of commercially available body-implantable electronic medical devices. The class of implantable medical devices now includes pacemakers, implantable cardioverters, defibrillators, neural stimulators, and drug administering devices, among others. Today's state-of-the-art implantable medical devices are vastly more sophisticated and complex than early ones, capable of performing significantly more complex tasks. The therapeutic benefits of such devices have been well proven. As the functional sophistication and complexity of implantable medical device systems have increased over the years, it has become increasingly useful to include a system for facilitating communication between one implanted device and another implanted or external device, for example, a programming console, monitoring system, or the like. Shortly after the introduction of the earliest pacemakers, it became apparent that it would be desirable for physicians to non-invasively obtain information regarding the operational status of the implanted device, and/or to exercise at least some control over the device, e.g., to turn the device on or off or adjust the pacing rate, after implant. As new, more advanced features have been incorporated into implantable devices, it has been increasingly useful to convey correspondingly more information to/from the device relating to the selection and control of those features. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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•

Method and apparatus for medical intervention procedure planning Inventor(s): Okerlund, Darin R.; (Muskego, WI), Reddy, Shankara B.; (Cedarburg, WI), Sra, Jasbir S.; (Pewaukee, WI) Correspondence: Cantor Colburn, Llp; 55 Griffin Road South; Bloomfield; CT; 06002 Patent Application Number: 20040087850 Date filed: November 1, 2002 Abstract: An imaging system for use in medical intervention procedure planning includes a medical scanner system for generating a volume of cardiac image data, a data acquisition system for acquiring the volume of cardiac image data, an image generation system for generating a viewable image from the volume of cardiac image data, a database for storing information from the data acquisition and image generation systems, an operator interface system for managing the medical scanner system, the data acquisition system, the image generation system, and the database, and a postprocessing system for analyzing the volume of cardiac image data, displaying the viewable image and being responsive to the operator interface system. The operator interface system includes instructions for using the volume of cardiac image data and the viewable image for bi-ventricular pacing planning, atrial fibrillation procedure planning, or atrial flutter procedure planning. Excerpt(s): This invention relates generally to an imaging system, and more particularly to a method and apparatus for use of the imaging system in medical intervention procedure planning. Medical diagnostic and imaging systems are present in modern health care facilities. Such systems provide invaluable tools for identifying, diagnosing and treating physical conditions and greatly reduce the need for surgical diagnostic intervention. In many instances, final diagnosis and treatment proceed only after an attending physician or radiologist has complemented conventional examinations with detailed images of relevant areas and tissues via one or more imaging modalities. Medical diagnosis and treatment can also be performed by using an interventional procedure such as congestive heart failure (CHF) intervention. It is estimated that approximately 6-7 million people in the United States and Europe have CHF. Some patients with CHF also experience left bundle branch block (LBBB), which negatively impacts the electrical conduction system of the heart. In patients with CHF and LBBB, delayed left ventricular ejection results from delayed ventricular depolarization, and in the presence of LBBB, ventricular contraction is asymmetrical, which causes ineffective contraction of the left ventricle. Cardiac resynchronization therapy, where both the right ventricle (RV) and left ventricle (LV) are paced simultaneously, has been shown to be effective in improving symptons in patients with CHF and LBBB. One current clinical treatment for this condition is interventional bi-ventricular pacing, which involves: positioning RV and right atrial (RA) leads, positioning a sheath in the coronary sinus (CS), performing a CS angiogram to delineate a suitable branch for the LV lead placement, placing the lead for LV pacing in the posterior or lateral branches of the CS, and applying pacing signals to the RV and LV leads to simultaneously pace the RV and LV for synchronization. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method of using spectral measures to distinguish among atrial fibrillation, atrial flutter and other cardiac rhythms Inventor(s): Reddy, Shankara; (Cedarburg, WI), Taha, Basel; (Menomonee Falls, WI), Xue, Joel; (Germantown, WI) Correspondence: Jon P. Christensen; Welsh & Katz, LTD.; 22nd Floor; 120 South Riverside Plaza; Chicago; IL; 60606; US Patent Application Number: 20020120206 Date filed: December 26, 2000 Abstract: A method and apparatus are provided for differentiating among atrial-flutter, atrial-fibrillation and other cardiac rhythms. The method includes the steps of estimating a spectral entropy of atrial cardiac activity from an electrocardiogram of a patient and determining that the patient has atrial fibrillation when the spectral entropy is greater than a predetermined value. Excerpt(s): The field of the invention relates to cardiac monitoring and more particularly to methods of distinguishing between different types of cardiac abnormalities. Atrial fibrillation (AFIB) and atrial flutter (AFL) are two of the most common abnormal cardiac rhythms, constituting up to 8% of electrocardiograms (ECGs) collected by hospitals. The two rhythms have clinically different implications and require different management. In addition, fibrillatory and flutter waves have different generating mechanisms in the atria. However, these two rhythms are often cross classified by physicians and by computerized ECG analysis systems for two main reasons. First, patterns of atrial flutter and fibrillation often coexist within the same ECG segment examined. The second cause of cross-classification is due to the difficulty of detecting atrial activity (visually or by computer time-based analysis) due to the overlying (and dominant) waveforms of ventricular origin (i.e., the QRS complex and T-wave), especially in the case of high ventricular rates. A method and apparatus are provided for differentiating among atrial-flutter, atrial- fibrillation and other cardiac rhythms. The method includes the steps of estimating a spectral entropy of atrial cardiac activity from an electrocardiogram of a patient and determining that the patient has atrial fibrillation when the spectral entropy is greater than a predetermined value. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with atrial flutter, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “atrial flutter” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on atrial flutter. You can also use this procedure to view pending patent applications concerning atrial flutter. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 5. PERIODICALS AND NEWS ON ATRIAL FLUTTER Overview In this chapter, we suggest a number of news sources and present various periodicals that cover atrial flutter.

News Services and Press Releases One of the simplest ways of tracking press releases on atrial flutter is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “atrial flutter” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to atrial flutter. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “atrial flutter” (or synonyms). The following was recently listed in this archive for atrial flutter: •

Death and stroke rates similar for atrial flutter and atrial fibrillation Source: Reuters Medical News Date: March 31, 2004

•

Chronic Atrial Flutter Increases Risk Of Thromboembolism Source: Reuters Medical News Date: November 19, 1997

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Radiofrequency Catheter Ablation Of Atrial Flutter Not Risk-Free Source: Reuters Medical News Date: August 14, 1995 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “atrial flutter” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “atrial flutter” (or synonyms). If you know the name of a company that is relevant to atrial flutter, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “atrial flutter” (or synonyms).

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Academic Periodicals covering Atrial Flutter Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to atrial flutter. In addition to these sources, you can search for articles covering atrial flutter that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 6. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for atrial flutter. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with atrial flutter. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to atrial flutter: Amiodarone •

Systemic - U.S. Brands: Cordarone; Cordarone I.V. http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202029.html

Quinidine •

Systemic - U.S. Brands: Cardioquin; Quinaglute Dura-tabs; Quinidex Extentabs; Quin-Release http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202498.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute7: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

7

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.8 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:9 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

8

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 9 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway10 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.11 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “atrial flutter” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 4321 40 295 0 24 4680

HSTAT12 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.13 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.14 Simply search by “atrial flutter” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

10

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

11

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 12 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 13 14

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists15 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.16 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.17 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

15 Adapted 16

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 17 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on atrial flutter can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to atrial flutter. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to atrial flutter. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “atrial flutter”:

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Arrhythmia http://www.nlm.nih.gov/medlineplus/arrhythmia.html Congenital Heart Disease http://www.nlm.nih.gov/medlineplus/congenitalheartdisease.html Heart Diseases http://www.nlm.nih.gov/medlineplus/heartdiseases.html Heart Failure http://www.nlm.nih.gov/medlineplus/heartfailure.html Pacemakers and Implantable Defibrillators http://www.nlm.nih.gov/medlineplus/pacemakersandimplantabledefibrillators.ht l You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to atrial flutter. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

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Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to atrial flutter. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with atrial flutter. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about atrial flutter. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “atrial flutter” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “atrial flutter”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “atrial flutter” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months.

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The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “atrial flutter” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.18

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

18

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)19: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

19

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

105

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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ATRIAL FLUTTER DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Ablate: In surgery, is to remove. [NIH] Ablation: The removal of an organ by surgery. [NIH] Abscess: A localized, circumscribed collection of pus. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Action Potentials: The electric response of a nerve or muscle to its stimulation. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association

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constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]

Ageing: A physiological or morphological change in the life of an organism or its parts, generally irreversible and typically associated with a decline in growth and reproductive vigor. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amiodarone: An antianginal and antiarrhythmic drug. It increases the duration of ventricular and atrial muscle action by inhibiting Na,K-activated myocardial adenosine triphosphatase. There is a resulting decrease in heart rate and in vascular resistance. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Angiogram: An x-ray of blood vessels; the person receives an injection of dye to outline the vessels on the x-ray. [NIH] Angulation: Deviation from the normal long axis, as in a fractured bone healed out of line. [NIH]

Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Antianginal: Counteracting angina or anginal conditions. [EU]

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Antiarrhythmic: An agent that prevents or alleviates cardiac arrhythmia. [EU] Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Arrhythmia: Any variation from the normal rhythm or rate of the heart beat. [NIH] Arrhythmogenic: Producing or promoting arrhythmia. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Asystole: Cardiac standstill or arrest; absence of a heartbeat; called also Beau's syndrome. [EU]

Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Atrial Flutter: Rapid, irregular atrial contractions due to an abnormality of atrial excitation. [NIH]

Atrial Function: The hemodynamic and electrophysiological action of the atria. [NIH] Atrioventricular: Pertaining to an atrium of the heart and to a ventricle. [EU] Atrioventricular Node: A small nodular mass of specialized muscle fibers located in the interatrial septum near the opening of the coronary sinus. It gives rise to the atrioventricular bundle of the conduction system of the heart. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Attenuated: Strain with weakened or reduced virulence. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to

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strains of unusual type. [EU] Auscultation: Act of listening for sounds within the body. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biphasic: Having two phases; having both a sporophytic and a gametophytic phase in the life cycle. [EU] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH]

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Bradycardia: Excessive slowness in the action of the heart, usually with a heart rate below 60 beats per minute. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium channel blocker: A drug used to relax the blood vessel and heart muscle, causing pressure inside blood vessels to drop. It also can regulate heart rhythm. [NIH] Calcium Channel Blockers: A class of drugs that act by selective inhibition of calcium influx through cell membranes or on the release and binding of calcium in intracellular pools. Since they are inducers of vascular and other smooth muscle relaxation, they are used in the drug therapy of hypertension and cerebrovascular spasms, as myocardial protective agents, and in the relaxation of uterine spasms. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume (volume per beat). [NIH] Cardiology: The study of the heart, its physiology, and its functions. [NIH] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cardioselective: Having greater activity on heart tissue than on other tissue. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardioversion: Electrical reversion of cardiac arrhythmias to normal sinus rhythm, formerly using alternatic current, but now employing direct current. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Catheter Ablation: Removal of tissue with electrical current delivered via electrodes positioned at the distal end of a catheter. Energy sources are commonly direct current (DCshock) or alternating current at radiofrequencies (usually 750 kHz). The technique is used most often to ablate the AV junction and/or accessory pathways in order to interrupt AV conduction and produce AV block in the treatment of various tachyarrhythmias. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral

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proteins are embedded to varying degrees. [EU] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Circulatory system: The system that contains the heart and the blood vessels and moves blood throughout the body. This system helps tissues get enough oxygen and nutrients, and it helps them get rid of waste products. The lymph system, which connects with the blood system, is often considered part of the circulatory system. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1,

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IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constriction: The act of constricting. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Defibrillation: The act to arrest the fibrillation of (heart muscle) by applying electric shock across the chest, thus depolarizing the heart cells and allowing normal rhythm to return. [EU]

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Dendritic: 1. Branched like a tree. 2. Pertaining to or possessing dendrites. [EU] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Diagnostic procedure: A method used to identify a disease. [NIH] Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disopyramide: Alpha-(2-(Bis(l-methylethyl)amino)ethyl)-alpha-phenyl-2-pyridine acetamide. A class I anti-arrhythmic agent (one that interferes directly with the depolarization of the cardiac membrane and thus serves as a membrane-stabilizing agent) with a depressant action on the heart similar to that of guanidine. It also possesses some anticholinergic and local anesthetic properties. [NIH] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diurnal: Occurring during the day. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Toxicity: Manifestations of the adverse effects of drugs administered therapeutically or in the course of diagnostic techniques. It does not include accidental or intentional poisoning for which specific headings are available. [NIH] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH] Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active

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second messenger. [NIH] Effector cell: A cell that performs a specific function in response to a stimulus; usually used to describe cells in the immune system. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Electric shock: A dangerous patho-physiological effect resulting from an electric current passing through the body of a human or animal. [NIH] Electrocardiogram: Measurement of electrical activity during heartbeats. [NIH] Electrocardiography: Recording of the moment-to-moment electromotive forces of the heart as projected onto various sites on the body's surface, delineated as a scalar function of time. [NIH]

Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Embolism: Blocking of a blood vessel by a blood clot or foreign matter that has been transported from a distant site by the blood stream. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Endocardium: The innermost layer of the heart, comprised of endothelial cells. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Exercise Test: Controlled physical activity, more strenuous than at rest, which is performed

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in order to allow assessment of physiological functions, particularly cardiovascular and pulmonary, but also aerobic capacity. Maximal (most intense) exercise is usually required but submaximal exercise is also used. The intensity of exercise is often graded, using criteria such as rate of work done, oxygen consumption, and heart rate. Physiological data obtained from an exercise test may be used for diagnosis, prognosis, and evaluation of disease severity, and to evaluate therapy. Data may also be used in prescribing exercise by determining a person's exercise capacity. [NIH] Exercise Tolerance: The exercise capacity of an individual as measured by endurance (maximal exercise duration and/or maximal attained work load) during an exercise test. [NIH]

Extracellular: Outside a cell or cells. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrillation: A small, local, involuntary contraction of muscle, invisible under the skin, resulting from spontaneous activation of single muscle cells or muscle fibres. [EU] Fluoroscopy: Production of an image when X-rays strike a fluorescent screen. [NIH] Flutter: A rapid vibration or pulsation. [EU] Fossa: A cavity, depression, or pit. [NIH] Fulguration: Destroying tissue using an electric current. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Therapy: The introduction of new genes into cells for the purpose of treating disease by restoring or adding gene expression. Techniques include insertion of retroviral vectors, transfection, homologous recombination, and injection of new genes into the nuclei of single cell embryos. The entire gene therapy process may consist of multiple steps. The new genes may be introduced into proliferating cells in vivo (e.g., bone marrow) or in vitro (e.g., fibroblast cultures) and the modified cells transferred to the site where the gene expression is required. Gene therapy may be particularly useful for treating enzyme deficiency diseases, hemoglobinopathies, and leukemias and may also prove useful in restoring drug sensitivity, particularly for leukemia. [NIH] Generator: Any system incorporating a fixed parent radionuclide from which is produced a daughter radionuclide which is to be removed by elution or by any other method and used in a radiopharmaceutical. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH]

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Grafting: The operation of transfer of tissue from one site to another. [NIH] Guanidine: A strong organic base existing primarily as guanidium ions at physiological pH. It is found in the urine as a normal product of protein metabolism. It is also used in laboratory research as a protein denaturant. (From Martindale, the Extra Pharmacopoeia, 30th ed and Merck Index, 12th ed) It is also used in the treatment of myasthenia and as a fluorescent probe in HPLC. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heart Transplantation: The transference of a heart from one human or animal to another. [NIH]

Heartbeat: One complete contraction of the heart. [NIH] Hemodynamics: The movements of the blood and the forces involved in systemic or regional blood circulation. [NIH] Hemoglobinopathies: A group of inherited disorders characterized by structural alterations within the hemoglobin molecule. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthyroidism: Excessive functional activity of the thyroid gland. [NIH] Hypertrophic cardiomyopathy: Heart muscle disease that leads to thickening of the heart walls, interfering with the heart's ability to fill with and pump blood. [NIH] Hypotension: Abnormally low blood pressure. [NIH] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Ileostomy: Surgical creation of an external opening into the ileum for fecal diversion or drainage. Loop or tube procedures are most often employed. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH]

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In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Inferior vena cava: A large vein that empties into the heart. It carries blood from the legs and feet, and from organs in the abdomen and pelvis. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intracellular: Inside a cell. [NIH] Intravascular: Within a vessel or vessels. [EU] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ion Exchange: Reversible chemical reaction between a solid, often an ION exchange resin, and a fluid whereby ions may be exchanged from one substance to another. This technique is used in water purification, in research, and in industry. [NIH] Ionization: 1. Any process by which a neutral atom gains or loses electrons, thus acquiring a net charge, as the dissociation of a substance in solution into ions or ion production by the passage of radioactive particles. 2. Iontophoresis. [EU] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH]

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Iontophoresis: Therapeutic introduction of ions of soluble salts into tissues by means of electric current. In medical literature it is commonly used to indicate the process of increasing the penetration of drugs into surface tissues by the application of electric current. It has nothing to do with ion exchange, air ionization nor phonophoresis, none of which requires current. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Length of Stay: The period of confinement of a patient to a hospital or other health facility. [NIH]

Lesion: An area of abnormal tissue change. [NIH] Leukemia: Cancer of blood-forming tissue. [NIH] Life cycle: The successive stages through which an organism passes from fertilized ovum or spore to the fertilized ovum or spore of the next generation. [NIH] Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Lung Transplantation: The transference of either one or both of the lungs from one human or animal to another. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant tumor: A tumor capable of metastasizing. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Menopause: Permanent cessation of menstruation. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH]

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Milk Thistle: The plant Silybum marianum in the family Asteraceae containing the bioflavonoid complex silymarin. For centuries this has been used traditionally to treat liver disease. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Multiple Myeloma: A malignant tumor of plasma cells usually arising in the bone marrow; characterized by diffuse involvement of the skeletal system, hyperglobulinemia, Bence-Jones proteinuria, and anemia. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Muscle relaxant: An agent that specifically aids in reducing muscle tension, as those acting at the polysynaptic neurons of motor nerves (e.g. meprobamate) or at the myoneural junction (curare and related compounds). [EU] Muscle Spindles: Mechanoreceptors found between skeletal muscle fibers. Muscle spindles are arranged in parallel with muscle fibers and respond to the passive stretch of the muscle, but cease to discharge if the muscle contracts isotonically, thus signaling muscle length. The muscle spindles are the receptors responsible for the stretch or myotactic reflex. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myotonic Dystrophy: A condition presenting muscle weakness and wasting which may be progressive. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Necrotizing Enterocolitis: A condition in which part of the tissue in the intestines is destroyed. Occurs mainly in under-weight newborn babies. A temporary ileostomy may be necessary. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH]

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Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Ossification: The formation of bone or of a bony substance; the conversion of fibrous tissue or of cartilage into bone or a bony substance. [EU] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Pacemaker: An object or substance that influences the rate at which a certain phenomenon occurs; often used alone to indicate the natural cardiac pacemaker or an artificial cardiac pacemaker. In biochemistry, a substance whose rate of reaction sets the pace for a series of interrelated reactions. [EU] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Parathyroid: 1. Situated beside the thyroid gland. 2. One of the parathyroid glands. 3. A sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Parathyroid Glands: Two small paired endocrine glands in the region of the thyroid gland. They secrete parathyroid hormone and are concerned with the metabolism of calcium and phosphorus. [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural

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and functional changes in tissues and organs of the body caused by the disease). [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Pericarditis: Inflammation of the pericardium. [EU] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Periodicity: The tendency of a phenomenon to recur at regular intervals; in biological systems, the recurrence of certain activities (including hormonal, cellular, neural) may be annual, seasonal, monthly, daily, or more frequently (ultradian). [NIH] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenyl: Ingredient used in cold and flu remedies. [NIH] Phenytoin: An anticonvulsant that is used in a wide variety of seizures. It is also an antiarrhythmic and a muscle relaxant. The mechanism of therapeutic action is not clear, although several cellular actions have been described including effects on ion channels, active transport, and general membrane stabilization. The mechanism of its muscle relaxant effect appears to involve a reduction in the sensitivity of muscle spindles to stretch. Phenytoin has been proposed for several other therapeutic uses, but its use has been limited by its many adverse effects and interactions with other drugs. [NIH] Phonophoresis: Use of ultrasound to increase the percutaneous adsorption of drugs. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH]

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Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasmid: An autonomously replicating, extra-chromosomal DNA molecule found in many bacteria. Plasmids are widely used as carriers of cloned genes. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postoperative: After surgery. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Procainamide: A derivative of procaine with less CNS action. [NIH] Procaine: A local anesthetic of the ester type that has a slow onset and a short duration of action. It is mainly used for infiltration anesthesia, peripheral nerve block, and spinal block. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1016). [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]

Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Prone: Having the front portion of the body downwards. [NIH]

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Prone Position: The posture of an individual lying face down. [NIH] Propafenone: An antiarrhythmia agent that is particularly effective in ventricular arrhythmias. It also has weak beta-blocking activity. The drug is generally well tolerated. [NIH]

Prophylaxis: An attempt to prevent disease. [NIH] Propranolol: A widely used non-cardioselective beta-adrenergic antagonist. Propranolol is used in the treatment or prevention of many disorders including acute myocardial infarction, arrhythmias, angina pectoris, hypertension, hypertensive emergencies, hyperthyroidism, migraine, pheochromocytoma, menopause, and anxiety. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Protective Agents: Synthetic or natural substances which are given to prevent a disease or disorder or are used in the process of treating a disease or injury due to a poisonous agent. [NIH]

Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulsation: A throb or rhythmical beat, as of the heart. [EU] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Quinidine: An optical isomer of quinine, extracted from the bark of the Cinchona tree and similar plant species. This alkaloid dampens the excitability of cardiac and skeletal muscles by blocking sodium and potassium currents across cellular membranes. It prolongs cellular action potential, and decreases automaticity. Quinidine also blocks muscarinic and alphaadrenergic neurotransmission. [NIH] Quinine: An alkaloid derived from the bark of the cinchona tree. It is used as an antimalarial drug, and is the active ingredient in extracts of the cinchona that have been used for that purpose since before 1633. Quinine is also a mild antipyretic and analgesic and has been used in common cold preparations for that purpose. It was used commonly and as a bitter and flavoring agent, and is still useful for the treatment of babesiosis. Quinine is also useful in some muscular disorders, especially nocturnal leg cramps and myotonia congenita, because of its direct effects on muscle membrane and sodium channels. The mechanisms of its antimalarial effects are not well understood. [NIH]

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Radiofrequency ablation: The use of electrical current to destroy tissue. [NIH] Radiologist: A doctor who specializes in creating and interpreting pictures of areas inside the body. The pictures are produced with x-rays, sound waves, or other types of energy. [NIH]

Radiopharmaceutical: Any medicinal product which, when ready for use, contains one or more radionuclides (radioactive isotopes) included for a medicinal purpose. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reentry: Reexcitation caused by continuous propagation of the same impulse for one or more cycles. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Retraction: 1. The act of drawing back; the condition of being drawn back. 2. Distal movement of teeth, usually accomplished with an orthodontic appliance. [EU] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating,

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deteriorating, or catabolic. [EU] Retrospective: Looking back at events that have already taken place. [NIH] Retroviral vector: RNA from a virus that is used to insert genetic material into cells. [NIH] Reversion: A return to the original condition, e. g. the reappearance of the normal or wild type in previously mutated cells, tissues, or organisms. [NIH] Rhythmicity: Regular periodicity. [NIH] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Rickets: A condition caused by deficiency of vitamin D, especially in infancy and childhood, with disturbance of normal ossification. The disease is marked by bending and distortion of the bones under muscular action, by the formation of nodular enlargements on the ends and sides of the bones, by delayed closure of the fontanelles, pain in the muscles, and sweating of the head. Vitamin D and sunlight together with an adequate diet are curative, provided that the parathyroid glands are functioning properly. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Scalpel: A small pointed knife with a convex edge. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Second Messenger Systems: Systems in which an intracellular signal is generated in response to an intercellular primary messenger such as a hormone or neurotransmitter. They are intermediate signals in cellular processes such as metabolism, secretion, contraction, phototransduction, and cell growth. Examples of second messenger systems are the adenyl cyclase-cyclic AMP system, the phosphatidylinositol diphosphate-inositol triphosphate system, and the cyclic GMP system. [NIH] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH] Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] Segregation: The separation in meiotic cell division of homologous chromosome pairs and their contained allelomorphic gene pairs. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Septal: An abscess occurring at the root of the tooth on the proximal surface. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Septum: A dividing wall or partition; a general term for such a structure. The term is often used alone to refer to the septal area or to the septum pellucidum. [EU] Septum Pellucidum: A triangular double membrane separating the anterior horns of the lateral ventricles of the brain. It is situated in the median plane and bounded by the corpus callosum and the body and columns of the fornix. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the

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circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Silymarin: A mixture of flavonoids extracted from seeds of the milk thistle, Silybum marianum. It consists primarily of three isomers: silicristin, silidianin, and silybin, its major component. Silymarin displays antioxidant and membrane stabilizing activity. It protects various tissues and organs against chemical injury, and shows potential as an antihepatoxic agent. [NIH] Sinoatrial Node: The small mass of modified cardiac muscle fibers located at the junction of the superior vena cava and right atrium. Contraction impulses probably start in this node, spread over the atrium and are then transmitted by the atrioventricular bundle to the ventricle. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Security: Government sponsored social insurance programs. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Solitary Nucleus: Gray matter located in the dorsomedial part of the medulla oblongata associated with the solitary tract. The solitary nucleus receives inputs from most organ systems including the terminations of the facial, glossopharyngeal, and vagus nerves. It is a major coordinator of autonomic nervous system regulation of cardiovascular, respiratory, gustatory, gastrointestinal, and chemoreceptive aspects of homeostasis. The solitary nucleus is also notable for the large number of neurotransmitters which are found therein. [NIH] Sotalol: An adrenergic beta-antagonist that is used in the treatment of life-threatening arrhythmias. [NIH] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and

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the extents of these reactions. [NIH] Spike: The activation of synapses causes changes in the permeability of the dendritic membrane leading to changes in the membrane potential. This difference of the potential travels along the axon of the neuron and is called spike. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Stabilization: The creation of a stable state. [EU] Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Sterile: Unable to produce children. [NIH] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subcutaneous: Beneath the skin. [NIH] Superior vena cava: Vein which returns blood from the head and neck, upper limbs, and thorax. It is formed by the union of the two brachiocephalic veins. [NIH] Supine: Having the front portion of the body upwards. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Supraventricular: Situated or occurring above the ventricles, especially in an atrium or atrioventricular node. [EU] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Syncope: A temporary suspension of consciousness due to generalized cerebral schemia, a faint or swoon. [EU] Systemic: Affecting the entire body. [NIH]

Dictionary 129

Tachyarrhythmia: Tachycardia associated with an irregularity in the normal heart rhythm. [EU]

Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Tachycardia, Ventricular: An abnormally rapid ventricular rhythm with wide QRS complexes, usually in excess of 150 per minute. It is generated within the ventricle, below the Bundle of His, and is most commonly associated with atrioventricular dissociation. [NIH] Terminalis: A groove on the lateral surface of the right atrium. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Transcutaneous: Transdermal. [EU] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Tricuspid Valve: The valve consisting of three cusps situated between the right atrium and right ventricle of the heart. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for

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nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Vagal: Pertaining to the vagus nerve. [EU] Vagus Nerve: The 10th cranial nerve. The vagus is a mixed nerve which contains somatic afferents (from skin in back of the ear and the external auditory meatus), visceral afferents (from the pharynx, larynx, thorax, and abdomen), parasympathetic efferents (to the thorax and abdomen), and efferents to striated muscle (of the larynx and pharynx). [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vascular Resistance: An expression of the resistance offered by the systemic arterioles, and to a lesser extent by the capillaries, to the flow of blood. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Vena: A vessel conducting blood from the capillary bed to the heart. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Verapamil: A calcium channel blocker that is a class IV anti-arrhythmia agent. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral Afferents: The sensory fibers innervating the viscera. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]

131

INDEX A Ablate, 23, 107, 111 Abscess, 107, 126 Acetylcholine, 70, 71, 107, 112, 121 Acidosis, 74, 107 Action Potentials, 4, 7, 48, 107 Adaptation, 76, 107 Adenine, 107 Adenosine, 18, 28, 107, 108, 122 Adjustment, 107 Adrenal Medulla, 107, 115, 121 Adrenergic, 4, 66, 71, 107, 115, 124, 127, 128 Adverse Effect, 107, 114, 122, 127 Affinity, 107, 127 Agar, 108, 122 Ageing, 71, 108 Algorithms, 108, 110 Alkaline, 107, 108, 111 Alkaloid, 108, 124 Alternative medicine, 82, 108 Amiodarone, 16, 36, 54, 58, 86, 108 Anaesthesia, 108, 118 Anatomical, 70, 71, 75, 108, 109 Anemia, 108, 120 Anesthesia, 66, 108, 123 Angina, 108, 124 Angina Pectoris, 108, 124 Angiogram, 79, 108 Angulation, 66, 108 Animal model, 5, 108 Antianginal, 108 Antiarrhythmic, 11, 18, 19, 25, 31, 33, 37, 38, 39, 43, 46, 66, 67, 70, 73, 108, 109 Antibodies, 109, 123 Antibody, 12, 108, 109, 112, 117, 127 Anticholinergic, 109, 114 Anticonvulsant, 109, 122 Antigen, 107, 109, 112, 117 Antioxidant, 109, 127 Anxiety, 77, 109, 124 Aorta, 109, 130 Arrhythmia, 5, 8, 11, 16, 29, 43, 58, 62, 64, 65, 68, 71, 74, 76, 96, 109, 130 Arrhythmogenic, 21, 66, 109 Arteries, 15, 74, 109, 110, 113, 119, 120 Artery, 4, 8, 65, 109, 113, 124 Asystole, 38, 109

Atrial Function, 13, 109 Atrioventricular, 7, 12, 15, 17, 18, 29, 35, 47, 49, 50, 66, 70, 74, 77, 109, 127, 128, 129 Atrioventricular Node, 17, 109, 128 Atrium, 18, 36, 45, 63, 64, 65, 67, 68, 69, 71, 73, 77, 109, 127, 128, 129, 130 Attenuated, 27, 109 Atypical, 6, 7, 9, 18, 30, 31, 35, 40, 69, 70, 109 Auscultation, 47, 110 Autonomic, 17, 70, 71, 77, 107, 110, 121, 127, 128 Autonomic Nervous System, 70, 71, 77, 110, 127, 128 B Bacteria, 109, 110, 119, 123 Bacterial Physiology, 107, 110 Bacteriophage, 110, 122 Benign, 68, 110 Biotechnology, 6, 82, 91, 110 Biphasic, 17, 110 Blood Coagulation, 110, 111 Blood pressure, 110, 117, 120, 127 Blood vessel, 108, 110, 111, 112, 115, 119, 122, 127, 128, 129, 130 Body Fluids, 110, 111, 127 Bolus, 54, 110 Bolus infusion, 110 Bone Marrow, 110, 116, 120 Bradycardia, 72, 111 Bypass, 4, 5, 8, 111 C Calcium, 66, 67, 111, 112, 121, 130 Calcium channel blocker, 66, 67, 111, 130 Calcium Channel Blockers, 66, 67, 111 Carcinogenic, 111, 118 Cardiac Output, 63, 68, 72, 111 Cardiomyopathy, 111 Cardioselective, 111, 124 Cardioversion, 13, 15, 17, 22, 23, 25, 27, 29, 36, 38, 39, 43, 47, 50, 62, 64, 68, 76, 77, 111 Case report, 7, 10, 22, 28, 111 Caudal, 111, 117, 123 Cell, 76, 110, 111, 112, 113, 114, 115, 116, 118, 120, 121, 122, 123, 125, 126, 129, 130 Cell Division, 110, 111, 122, 126

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Cell membrane, 111, 114 Central Nervous System, 107, 110, 112, 116 Cerebral, 44, 112, 115, 128 Cerebrovascular, 67, 111, 112 Cerebrum, 112 Cholinergic, 70, 112 Chromosomal, 112, 123 Chromosome, 112, 126 Chronic, 27, 29, 36, 42, 47, 64, 66, 76, 81, 112, 128 Circulatory system, 77, 112 Clinical Medicine, 112, 123 Clinical trial, 3, 91, 112, 113, 125 Cloning, 110, 112 Collagen, 4, 112, 123 Complement, 112, 113 Complementary and alternative medicine, 57, 60, 113 Complementary medicine, 57, 113 Computational Biology, 91, 113 Conception, 113, 116 Conduction, 4, 8, 9, 11, 12, 13, 14, 15, 18, 19, 21, 24, 26, 34, 35, 37, 38, 40, 41, 42, 43, 46, 48, 49, 50, 57, 66, 68, 70, 71, 72, 74, 76, 79, 109, 111, 113 Congestive heart failure, 77, 79, 113 Connective Tissue, 110, 112, 113, 116 Consciousness, 113, 114, 128 Constriction, 113, 119 Contraindications, ii, 113 Controlled study, 40, 113 Coronary, 4, 7, 8, 24, 44, 49, 62, 68, 74, 79, 108, 109, 113, 119, 120 Coronary Thrombosis, 113, 119, 120 Curative, 113, 126, 129 D Defibrillation, 64, 76, 113 Dendritic, 114, 128 Density, 34, 35, 71, 74, 75, 114, 121, 127 Depolarization, 63, 65, 79, 114 Diagnostic procedure, 61, 82, 114 Diastole, 114 Diastolic, 14, 39, 114, 117 Direct, iii, 5, 14, 15, 34, 36, 38, 39, 43, 46, 85, 111, 112, 114, 124, 125, 128 Disopyramide, 19, 114 Dissociation, 107, 114, 118, 129 Distal, 65, 66, 111, 114, 115, 125 Diurnal, 71, 114 Dizziness, 63, 114 Dorsal, 114, 123

Drive, ii, vi, 53, 71, 114 Drug Interactions, 4, 86, 114 Drug Toxicity, 74, 114 Dysplasia, 21, 114 E Echocardiography, 15, 22, 27, 37, 42, 48, 114 Edema, 39, 114 Effector, 107, 112, 114, 115 Effector cell, 115 Efficacy, 4, 7, 17, 23, 24, 40, 43, 115 Elastin, 112, 115 Electric shock, 113, 115 Electrocardiogram, 20, 42, 46, 58, 68, 70, 80, 115 Electrocardiography, 46, 69, 75, 115 Electrode, 10, 22, 26, 40, 47, 64, 66, 76, 77, 115 Electrolyte, 74, 115, 123, 127 Electrophysiological, 18, 33, 65, 71, 109, 115 Embolism, 44, 115 Embryo, 115, 118 Endocardium, 66, 115 Endothelial cell, 115 Environmental Health, 90, 92, 115 Enzymatic, 111, 113, 115 Enzyme, 114, 115, 116, 130 Epinephrine, 107, 115, 121 Evoke, 115, 128 Excitability, 71, 115, 124 Excitation, 35, 64, 69, 71, 75, 76, 109, 115, 121 Exercise Test, 115, 116 Exercise Tolerance, 17, 116 Extracellular, 4, 113, 116, 127 F Family Planning, 91, 116 Fetus, 12, 116, 123 Fluoroscopy, 22, 28, 116 Fossa, 46, 116 Fulguration, 14, 116 G Ganglia, 107, 116, 121, 128 Gene, 75, 76, 110, 116, 126 Gene Expression, 116 Gene Therapy, 75, 76, 116 Generator, 34, 40, 63, 116 Gestation, 116, 122 Gland, 107, 116, 117, 121, 128 Governing Board, 116, 123 Grafting, 4, 8, 117

133

Guanidine, 114, 117 H Heart failure, 117 Heart Transplantation, 9, 25, 117 Heartbeat, 72, 77, 109, 117 Hemodynamics, 77, 117 Hemoglobinopathies, 116, 117 Hemorrhage, 117, 128 Heredity, 116, 117 Homologous, 116, 117, 126 Hybrid, 11, 43, 117 Hydrogen, 107, 117, 120 Hydroxylysine, 112, 117 Hydroxyproline, 112, 117 Hypertension, 111, 117, 124 Hyperthyroidism, 117, 124 Hypertrophic cardiomyopathy, 7, 117 Hypotension, 68, 117 Hypothalamus, 110, 117 Hypoxia, 74, 117 I Ileostomy, 117, 120 In vitro, 71, 116, 117, 118 In vivo, 71, 76, 116, 117, 118 Incision, 44, 118 Induction, 30, 31, 71, 118 Infancy, 32, 118, 126 Infarction, 118 Inferior vena cava, 17, 22, 28, 34, 62, 66, 78, 118 Infusion, 68, 70, 118 Initiation, 30, 34, 43, 70, 71, 118 Innervation, 71, 118 Insight, 5, 9, 118 Intermittent, 65, 118 Intestines, 118, 120, 126 Intracellular, 111, 118, 123, 126 Intravascular, 65, 66, 118 Intravenous, 54, 118 Intrinsic, 72, 77, 108, 118 Invasive, 34, 65, 70, 118 Involuntary, 116, 118, 120 Ion Channels, 118, 122 Ion Exchange, 118, 119 Ionization, 118, 119 Ions, 114, 115, 117, 118, 119 Iontophoresis, 4, 118, 119 Ischemia, 74, 108, 119 K Kb, 90, 119 L Length of Stay, 4, 119

Lesion, 65, 119 Leukemia, 116, 119 Life cycle, 110, 119 Ligaments, 113, 119 Localization, 9, 119 Localized, 107, 119, 122 Loop, 8, 19, 117, 119 Lung Transplantation, 9, 28, 119 Lymph, 112, 115, 119 Lymphoid, 109, 119 Lymphoma, 57, 59, 119 M Malignant, 119, 120 Malignant tumor, 119, 120 Medial, 4, 119 Medicament, 67, 119 MEDLINE, 91, 119 Membrane, 111, 113, 114, 115, 118, 119, 122, 124, 126, 127, 128 Menopause, 119, 124 MI, 105, 119 Microbiology, 107, 109, 119 Milk Thistle, 120, 127 Modification, 32, 44, 67, 120, 124 Molecular, 91, 93, 110, 113, 120 Molecule, 109, 113, 114, 115, 117, 120, 123, 125, 130 Monitor, 4, 65, 68, 120 Morphological, 108, 115, 120 Morphology, 4, 9, 13, 40, 70, 72, 120 Multiple Myeloma, 18, 120 Muscle Fibers, 109, 120, 127 Muscle relaxant, 120, 122 Muscle Spindles, 120, 122 Myocardial infarction, 44, 113, 119, 120, 124 Myocardium, 108, 119, 120 Myotonic Dystrophy, 21, 120 N Necrosis, 118, 119, 120 Necrotizing Enterocolitis, 20, 120 Neoplastic, 119, 120 Nerve, 59, 107, 108, 118, 120, 121, 123, 128, 129, 130 Nervous System, 70, 71, 110, 112, 120, 121, 128 Neural, 78, 121, 122 Neuromuscular, 107, 121 Neuromuscular Junction, 107, 121 Neurons, 116, 120, 121, 128 Neurophysiology, 114, 121 Neurotransmitter, 107, 118, 121, 126

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Norepinephrine, 70, 107, 121 Nuclei, 116, 121 O Opacity, 114, 121 Ossification, 121, 126 Outpatient, 43, 121 P Pacemaker, 20, 34, 36, 63, 64, 67, 72, 74, 76, 78, 121 Palliative, 121, 129 Parathyroid, 121, 126 Parathyroid Glands, 121, 126 Paroxysmal, 7, 38, 39, 45, 64, 71, 76, 108, 121 Pathogenesis, 71, 121 Pathologic, 72, 107, 113, 121 Pelvis, 118, 122 Perception, 41, 122 Perfusion, 68, 117, 122 Pericarditis, 54, 122 Perinatal, 8, 122 Periodicity, 122, 126 Pharmaceutical Preparations, 73, 122 Pharmacologic, 36, 108, 122, 129 Phenyl, 114, 122 Phenytoin, 13, 122 Phonophoresis, 119, 122 Phosphorus, 111, 121, 122 Physiologic, 72, 122, 125 Physiology, 18, 111, 115, 121, 122 Plants, 108, 120, 121, 122 Plaque, 4, 122 Plasma, 109, 111, 120, 122, 123 Plasma cells, 109, 120, 123 Plasmid, 76, 123, 130 Platelets, 123, 129 Platinum, 119, 123 Pneumonia, 113, 123 Poisoning, 114, 123 Polypeptide, 112, 123 Posterior, 22, 66, 79, 114, 123 Postoperative, 5, 25, 36, 123 Potassium, 4, 67, 73, 123, 124 Practice Guidelines, 92, 123 Precursor, 7, 114, 115, 121, 123, 130 Prenatal, 20, 115, 123 Procainamide, 19, 38, 123 Procaine, 123 Progression, 15, 108, 123 Progressive, 38, 120, 123 Projection, 121, 123 Prolapse, 22, 123

Proline, 112, 117, 123 Prone, 17, 123, 124 Prone Position, 17, 124 Propafenone, 36, 124 Prophylaxis, 67, 73, 124 Propranolol, 23, 124 Prospective study, 19, 43, 124 Protective Agents, 111, 124 Protein S, 110, 124 Proteins, 109, 111, 112, 120, 122, 124 Proteinuria, 120, 124 Public Policy, 91, 124 Pulmonary, 23, 28, 39, 41, 110, 116, 124, 130 Pulmonary Artery, 110, 124, 130 Pulsation, 116, 124 Pulse, 34, 62, 120, 124 Q Quality of Life, 5, 124 Quinidine, 15, 36, 54, 86, 124 Quinine, 124 R Radiofrequency ablation, 6, 11, 12, 16, 21, 29, 37, 39, 40, 41, 43, 48, 125 Radiologist, 79, 125 Radiopharmaceutical, 116, 125 Randomized, 5, 10, 28, 39, 40, 41, 115, 125 Randomized Controlled Trials, 5, 125 Receptor, 107, 109, 125 Recombinant, 125, 130 Recombination, 116, 125 Recurrence, 16, 27, 41, 43, 67, 122, 125 Reentry, 5, 7, 45, 49, 65, 71, 75, 77, 125 Refer, 1, 112, 114, 119, 125, 126 Refractory, 11, 29, 70, 71, 125 Regimen, 115, 125 Regurgitation, 14, 125 Remission, 125 Resection, 12, 125 Respiration, 120, 125 Retraction, 65, 125 Retrograde, 72, 125 Retrospective, 5, 126 Retroviral vector, 116, 126 Reversion, 23, 111, 126 Rhythmicity, 74, 126 Ribose, 107, 126 Rickets, 20, 126 Risk factor, 26, 43, 124, 126 S Scalpel, 4, 126 Screening, 112, 126

135

Second Messenger Systems, 126 Segmental, 28, 126 Segmentation, 126 Segregation, 66, 125, 126 Seizures, 121, 122, 126 Sensor, 65, 126 Septal, 44, 49, 126 Septic, 18, 126 Septum, 41, 77, 109, 126 Septum Pellucidum, 126 Shock, 39, 111, 126, 129 Side effect, 67, 73, 85, 107, 127, 129 Silymarin, 58, 120, 127 Sinoatrial Node, 74, 127 Skeletal, 120, 124, 127 Smooth muscle, 111, 127 Social Environment, 124, 127 Social Security, 125, 127 Sodium, 66, 124, 127 Solitary Nucleus, 110, 127 Sotalol, 30, 45, 70, 127 Sound wave, 113, 125, 127 Spatial disorientation, 114, 127 Specialist, 97, 127 Species, 115, 117, 124, 127, 130 Specificity, 74, 108, 127 Spike, 49, 128 Spinal cord, 112, 121, 128 Stabilization, 122, 128 Stasis, 77, 128 Statistically significant, 71, 128 Sterile, 54, 121, 128 Stimulus, 65, 72, 114, 115, 118, 128, 129 Stress, 110, 128 Stroke, 5, 26, 73, 81, 90, 111, 128 Subacute, 21, 128 Subcutaneous, 114, 128 Superior vena cava, 127, 128 Supine, 71, 128 Suppression, 36, 128 Supraventricular, 7, 22, 43, 68, 71, 72, 74, 128 Sympathetic Nervous System, 110, 128 Sympathomimetic, 20, 115, 121, 128 Symptomatic, 30, 45, 128 Synapse, 107, 121, 128, 129 Syncope, 38, 46, 128 Systemic, 86, 109, 110, 115, 117, 128, 130

T Tachyarrhythmia, 62, 129 Tachycardia, 4, 7, 9, 10, 11, 12, 18, 22, 23, 25, 33, 43, 45, 47, 50, 54, 62, 66, 68, 71, 72, 78, 129 Tachycardia, Ventricular, 72, 129 Terminalis, 12, 21, 42, 70, 129 Therapeutics, 50, 86, 129 Threshold, 77, 115, 117, 129 Thrombosis, 124, 128, 129 Thrombus, 27, 42, 44, 113, 118, 129 Tone, 70, 71, 129 Tonus, 129 Tooth Preparation, 107, 129 Toxic, iv, 129 Toxicity, 114, 129 Toxicology, 92, 129 Transcutaneous, 59, 129 Transfection, 110, 116, 129 Transmitter, 107, 118, 121, 129 Trauma, 66, 120, 129 Tricuspid Valve, 12, 22, 65, 78, 129 Tryptophan, 112, 129 V Vagal, 70, 71, 130 Vagus Nerve, 127, 130 Vascular, 108, 111, 118, 129, 130 Vascular Resistance, 108, 130 Vector, 8, 19, 75, 130 Vein, 28, 41, 65, 68, 118, 128, 130 Vena, 130 Ventricle, 63, 68, 79, 109, 117, 124, 127, 129, 130 Ventricular, 4, 7, 38, 39, 49, 50, 58, 63, 66, 68, 69, 72, 77, 78, 79, 80, 108, 124, 129, 130 Verapamil, 23, 50, 130 Veterinary Medicine, 54, 91, 130 Virulence, 109, 129, 130 Virus, 110, 122, 126, 130 Visceral, 110, 130 Visceral Afferents, 110, 130 Vitro, 130 Vivo, 130 W White blood cell, 109, 119, 123, 130 X Xenograft, 108, 130 X-ray, 108, 116, 125, 130

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