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Right and Left Atrial Flutter: How To Differentiate Them on the Basis of Surface Electrocardiogram?

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Cardiac Arrhythmias 2005

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Conclusions

Resetting responses and response to entrainment have confirmed the reentrant nature of flutter and established the presence of a fully excitable gap in the majority of patients. During atrial flutter, the use of 3D electroanatomic mapping studies and the entrainment pacing technique have aided in defining the mechanism of the arrhythmia with the activation sequence, providing information regarding the timing of intra-atrial events with respect to the surface electrocardiogram, especially for the non-CTI-dependent form and for left flutter.

Further study will be needed, however, to definite the precise boundaries of flutter and to better identify correlations between the location of the different electrophysiologic types of reentrant circuits and their electrocardiographic characteristics.

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References

  1. Disertori M, Inama G, Vergara G et al (1983) Evidence of a reentry circuit in the common type of atrial flutter in man. Circulation 67:434–440

    PubMed  CAS  Google Scholar 

  2. Waldo AL, Mackall JA, Biblo LA (1997) Mechanisms and medical management of patients with atrial flutter. Cardiol Clin 15:661–676

    PubMed  CAS  Google Scholar 

  3. Scheinman MM, Yang Y (2004) Atrial flutter: historical notes — Part 1. Pacing Clin Electrophysiol 27:379–381

    Article  PubMed  Google Scholar 

  4. Halligan SC, Gersh BJ, Brown RD Jr et al (2004) The natural history of lone atrial flutter. Ann Intern Med 140:265–268

    PubMed  Google Scholar 

  5. Calkins H, Leon AR, Deam AG et al (1994) Catheter ablation of atrial flutter using radiofrequency energy. Am J Cardiol 73:353–356

    Article  PubMed  CAS  Google Scholar 

  6. Saoudi N, Nair M, Abdelazziz A et al (1996) Electrocardiographic patterns and results of radiofrequency catheter ablation of clockwise type I atrial flutter. J Cardiovasc Electrophysiol 7:931–942

    PubMed  CAS  Google Scholar 

  7. Saoudi N, Cosio F, Waldo A et al (2001) A classification of atrial flutter and regular atrial tachycardia according to electrophysiological mechanisms and anatomical 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. Eur Heart J 22:1162–1182

    Article  PubMed  CAS  Google Scholar 

  8. Scheinman MM, Yang Y, Cheng J (2004) Atrial flutter: Part II. Nomenclature. Pacing Clin Electrophysiol 27:504–506

    Article  PubMed  Google Scholar 

  9. Kalman JM, Olgin JE, Saxon LA et al (1996) Activation and entrainment mapping defines the tricuspid annulus as the anterior barrier in typical atrial flutter. Circulation 94:398–406

    PubMed  CAS  Google Scholar 

  10. Nakagawa H, Lazzara R, Khastgir T et al (1996) Role of the tricuspid annulus and the eustachian valve/ridge on atrial flutter. Relevance to catheter ablation of the septal isthmus and a new technique for rapid identification of ablation success. Circulation 94:407–424

    PubMed  CAS  Google Scholar 

  11. Arribas F, Lopez-Gil M, Cosio FG et al (1997) The upper link of human common atrial flutter circuit: definition by multiple endocardial recordings during entrainment. Pacing Clin Electrophysiol 20:2924–2929

    Article  PubMed  CAS  Google Scholar 

  12. Kalman JM, Olgin JE, Saxon LA et al (1997) Electrocardiographic and electrophysiologic characterization of atypical atrial flutter in man: use of activation and entrainment mapping and implications for catheter ablation. J Cardiovasc Electrophysiol 8:121–144

    PubMed  CAS  Google Scholar 

  13. Milliez P, Richardson AW, Obioha-Ngwu O et al (2002) Variable electrocardiographic characteristics of isthmus-dependent atrial flutter. J Am Coll Cardiol 40:1125–1132

    Article  PubMed  Google Scholar 

  14. Chan DP, Van Hare GF, Mackall JA et al (2000) Importance of atrial flutter isthmus in postoperative intra-atrial reentrant tachycardia. Circulation 102:1283–1289

    PubMed  CAS  Google Scholar 

  15. Tsuchiya T, Okumura K, Tabuchi T et al (1996) The upper turnover site in the reentry circuit of common atrial flutter. Am J Cardiol 78:1439–1442

    Article  PubMed  CAS  Google Scholar 

  16. Inama G, Gramegna L, Pessano P et al (1998) Una esperienza italiana sull’ablazione transcatetere con radiofrequenza nel flutter atriale tipo Io: risultati e follow-up. G Ital Cardiol 28:666–677

    PubMed  CAS  Google Scholar 

  17. Inama G, Gramegna L, Pessano P et al (1998) Long-term results in radiofrequency catheter ablation of type 1 atrial flutter. G Ital Cardiol 28(Suppl 1): 371–374

    Google Scholar 

  18. Bochoeyer A, Yang Y, Cheng J et al (2003) Surface electrocardiographic characteristics of right and left atrial flutter. Circulation 108:60–66

    Article  PubMed  Google Scholar 

  19. Frame LH (1987) Double reentry: a mechanism of overdrive acceleration of reentrant tachycardias. Circulation 76(Suppl IV):430

    Google Scholar 

  20. Frame LH, Rhee EK, Bernstein RC et al (1996) Reversal of reentry and acceleration due to double-wave reentry: two mechanisms for failure to terminate tachycardias by rapid pacing. J Am Coll Cardiol 28:137–145

    Article  PubMed  CAS  Google Scholar 

  21. Cheng J, Cabeen JWR, Scheinman MM (1999) Right atrial flutter due to lower loop reentry: mechanisms and anatomic substrates. Circulation 99:1700–1705

    PubMed  CAS  Google Scholar 

  22. Zhang S, Younis G, Hariharan R et al (2004) Lower loop reentry as a mechanism of clockwise right atrial flutter. Circulation 109:1630–1635

    Article  PubMed  Google Scholar 

  23. Cheng J, Scheinman MM (1998) Acceleration of typical atrial flutter due to double-wave reentry induced by programmed electrical stimulation. Circulation 97:1589–1596

    PubMed  CAS  Google Scholar 

  24. Yang Y, Cheng J, Bochoeyer A et al (2001) Atypical right atrial flutter patterns. Circulation 103:3092–3098

    PubMed  CAS  Google Scholar 

  25. Kall J, Rubenstein DS, Kopp DE et al (2000) Atypical atrial flutter originating in the right atrial free wall. Circulation 101:270–279

    PubMed  CAS  Google Scholar 

  26. Nakagawa H, Shah N, Matsudaira K et al (2001) Characterization of reentrant circuit in macroreentrant right atrial tachycardia after surgical repair of congenital heart disease: isolated channels between scars allow ‘focal’ ablation. Circulation 103:699–709

    PubMed  CAS  Google Scholar 

  27. Feld GK, Shahandeh-Rad F (1992) Activation patterns in experimental canine atrial flutter produced by right atrial crush injury. J Am Coll Cardiol 20:441–451

    Article  PubMed  CAS  Google Scholar 

  28. Tai CT, Huang JL, Lin YK et al (2002) Noncontact three-dimensional mapping and ablation of upper loop re-entry originating in the right atrium. J Am Coll Cardiol 40:746–753

    Article  PubMed  Google Scholar 

  29. Lelorier P, Humphries KH, Krahn A et al (2004) Prognostic differences between atrial fibrillation and atrial flutter. Am J Cardiol 93:647–649

    Article  PubMed  Google Scholar 

  30. Vidaillet H, Granada JF, Chyou PH et al (2002) A population based study of mortality among patients with atrial fibrillation or flutter. Am J Med 113:365–370

    Article  PubMed  Google Scholar 

  31. Jaïs P, Shah DC, Haïssaguerre M et al (2000) Mapping and ablation of left atrial flutters. Circulation 101:2928–2934

    PubMed  Google Scholar 

  32. Ouyang F, Ernst S, Vogtmann T et al (2002) Characterization of reentrant circuits in left atrial macroreentrant tachycardia: critical isthmus block can prevent atrial tachycardia recurrence. Circulation 105:1934–1942

    Article  PubMed  Google Scholar 

  33. Cosio FG, Martin-Penato A, Pastor A et al (2003) Atypical flutter: a review. Pacing Clin Electrophysiol 26:2157–2169

    Article  PubMed  Google Scholar 

  34. Olgin JE, Jayachandran JV, Engesstein E et al (1998) Atrial macroreentry involving the myocardium of the coronary sinus: a unique mechanism for atypical flutter. J Cardiovasc Electrophysiol 9:1094–1099

    PubMed  CAS  Google Scholar 

  35. Marrouche NF, Natale A, Wazni OM et al (2004) Left septal atrial flutter: electrophysiology, anatomy, and results of ablation. Circulation 109:2440–2447

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Cardiology Department, Maggiore Hospital, Crema (Cremona), Italy

    G. Inama, C. Pedrinazzi, O. Durin, P. Gazzaniga & P. Agricola

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  1. G. Inama
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  2. C. Pedrinazzi
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  3. O. Durin
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  4. P. Gazzaniga
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  5. P. Agricola
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Editors and Affiliations

  1. Divisione di Cardiologia, Ospedale Umberto I, Via Circonvallazione 50, I-30174, Venezia Mestre

    Antonio Raviele MD

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Inama, G., Pedrinazzi, C., Durin, O., Gazzaniga, P., Agricola, P. (2006). Right and Left Atrial Flutter: How To Differentiate Them on the Basis of Surface Electrocardiogram?. In: Raviele, A. (eds) Cardiac Arrhythmias 2005. Springer, Milano. https://doi.org/10.1007/88-470-0371-7_1

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  • DOI: https://doi.org/10.1007/88-470-0371-7_1

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0370-5

  • Online ISBN: 978-88-470-0371-2

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