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. 2017 Jun;6(2):55-62.
doi: 10.15420/aer.2017.5.2.

Atrial Flutter, Typical and Atypical: A Review

Francisco G Cosío  1
Affiliations

Atrial Flutter, Typical and Atypical: A Review

Francisco G Cosío. Arrhythm Electrophysiol Rev. 2017 Jun.

Abstract

Clinical electrophysiology has made the traditional classification of rapid atrial rhythms into flutter and tachycardia of little clinical use. Electrophysiological studies have defined multiple mechanisms of tachycardia, both re-entrant and focal, with varying ECG morphologies and rates, authenticated by the results of catheter ablation of the focal triggers or critical isthmuses of re-entry circuits. In patients without a history of heart disease, cardiac surgery or catheter ablation, typical flutter ECG remains predictive of a right atrial re-entry circuit dependent on the inferior vena cava-tricuspid isthmus that can be very effectively treated by ablation, although late incidence of atrial fibrillation remains a problem. Secondary prevention, based on the treatment of associated atrial fibrillation risk factors, is emerging as a therapeutic option. In patients subjected to cardiac surgery or catheter ablation for the treatment of atrial fibrillation or showing atypical ECG patterns, macro-re-entrant and focal tachycardia mechanisms can be very complex and electrophysiological studies are necessary to guide ablation treatment in poorly tolerated cases.

Keywords: Typical atrial flutter; atypical atrial flutter; classification of atrial tachycardias; flutter ablation; macro-re-entrant atrial tachycardia.

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Conflict of interest statement

Disclosure: The author has no conflicts of interest to declare.

Figures

Figure 1:
Figure 1:. The ECG Pattern May Not Reflect the Mechanism
Figure 2:
Figure 2:. ECG of a Typical Atrial Flutter
Figure 3:
Figure 3:. Reverse (Clockwise) Typical Flutter
Figure 4:
Figure 4:. One to One AV Conduction in Flutter Slowed by Flecainide
Figure 5:
Figure 5:. Spontaneous 1:1 AV Conduction in Typical Flutter
Figure 6:
Figure 6:. Flutter Cardioversion by Rapid Stimulation
Figure 7:
Figure 7:. Atypical Right Atrial Macro-reentrant Circuits
Figure 8:
Figure 8:. Two Flutter Mechanisms, Typical and Atypical, in the Same Patient
Figure 9:
Figure 9:. Schematic Representation of Macro-re-entrant Tachycardia Mechanisms in the Left Atrium
Figure 10:
Figure 10:. Left Atrial Macro-reentrant Tachycardia in a Patient with Interatrial Block
See this image and copyright information in PMC

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