13 - Typical atrial flutter

Abstract

The term typical atrial flutter (AFL) is reserved for a macroreentrant circuit with the activation wavefront rotating clockwise or counterclockwise around the tricuspid annulus and using the cavotricuspid isthmus (CTI) as an essential part of the reentry circuit. Typical AFL is the most common type of macroreentrant atrial tachycardia. There are four main issues that must be addressed in the treatment of AFL: (1) ventricular rate control; (2) restoration of sinus rhythm; (3) maintenance of sinus rhythm; and (4) prevention of systemic embolization. Catheter ablation is recommended as first-line therapy for most patients with symptomatic or recurrent typical AFL, whether paroxysmal or persistent. The ablation procedure is associated with high long-term success rates (92% after a single procedure and 97% after multiple procedures), and low risk of serious complications (0.4%). In addition to improvement of symptoms and quality of life, successful ablation offers a potential cure of the arrhythmia, reducing the risk of thromboembolism, and potentially eliminating the need for long-term anticoagulation and antiarrhythmic drug therapy. The CTI is the ideal target of AFL ablation, and complete bidirectional CTI block is the primary endpoint of ablation of typical AFL.