Abstract
Since its first description about one century ago, our understanding of atrial flutter (AFL) circuits has considerably evolved. One AFL circuit can have variable electrocardiographic (ECG) manifestations depending on the presence of pre-existing atrial lesions, or impaired atrial substrate. Conversely, different (right sided or even left sided) atrial circuits including different mechanisms (macroreentrant, microreentrant, or focal) can present with a very similar surface ECG manifestation. The development of efficient high-resolution electroanatomical mapping systems has improved our knowledge about AFL mechanisms, as well as facilitated their curative treatment with radiofrequency catheter ablation. This article will review ECG features for typical and atypical flutters, and emphasize the limitations for circuit location from the surface ECG.
Highlights
Since its first description a century ago, our understanding of atrial flutter (AFL) has evolved, from a relatively simple and unique electrocardiographic (ECG) pattern corresponding to a right atrial macroreentry, to a variety of atrial tachycardias (ATs) originating from the right atrium as well as the left atrium, and resulting from different mechanisms
Counterclockwise AFL may be spontaneously associated with premature activation of the coronary sinus (CS) ostium and impulse collision at the isthmus of both the orthodromic CCW wavefront and another front emerging from the CS ostial region
Atrial flutter classically refers to the ECG pattern of an undulating wave with no electrical silence in at least one lead of the surface ECG
Summary
Sok-Sithikun Bun1*, Decebal Gabriel Latcu[1], Francis Marchlinski[2], and Nadir Saoudi[1,2]. Since its first description about one century ago, our understanding of atrial flutter (AFL) circuits has considerably evolved. One AFL circuit can have variable electrocardiographic (ECG) manifestations depending on the presence of pre-existing atrial lesions, or impaired atrial substrate. Different (right sided or even left sided) atrial circuits including different mechanisms (macroreentrant, microreentrant, or focal) can present with a very similar surface ECG manifestation. The development of efficient high-resolution electroanatomical mapping systems has improved our knowledge about AFL mechanisms, as well as facilitated their curative treatment with radiofrequency catheter ablation. This article will review ECG features for typical and atypical flutters, and emphasize the limitations for circuit location from the surface ECG. Typical atrial flutter † Atypical atrial flutter † ECG † Cavotricuspid isthmus dependent
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