Atrial Flutter: Mechanisms, Clinical Features, and Management

Atrial flutter was described by Jolly and Ritchie in 1911 (see reference 1 ). 1 However, it was not until recently that major advances have been made concerning its mechanism, diagnosis, and management. As a result of these advances, there is now a sophisticated understanding of the mechanisms of atrial flutter, new techniques to diagnose atrial flutter have evolved, and significant improvements in acute and long-term therapy of atrial flutter have become available. This chapter reviews these subjects.

[1]  J. Olgin,et al.  Role of right atrial endocardial structures as barriers to conduction during human type I atrial flutter. Activation and entrainment mapping guided by intracardiac echocardiography. , 1995, Circulation.

[2]  D. Shah,et al.  Three-dimensional mapping of the common atrial flutter circuit in the right atrium. , 1997, Circulation.

[3]  Arthur Grishman L'activité électrique auriculaire: Normale et pathologique , 1959 .

[4]  D L Packer,et al.  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. , 2000, Circulation.

[5]  F. Cosío,et al.  Mechanisms of entrainment of human common flutter studied with multiple endocardial recordings. , 1994, Circulation.

[6]  A. Waldo,et al.  Spontaneous onset of type I atrial flutter in patients. , 1996, Journal of the American College of Cardiology.

[7]  J. Wharton,et al.  Radiofrequency catheter ablation of supraventricular tachycardia substrates after mustard and senning operations for d-transposition of the great arteries. , 2000, Journal of the American College of Cardiology.

[8]  M. Scheinman,et al.  Mechanisms and Clinical Implications of Atypical Atrial Flutter , 1999, Journal of cardiovascular electrophysiology.

[9]  P. Sager,et al.  Efficacy of intravenous ibutilide for rapid termination of atrial fibrillation and atrial flutter: a dose-response study. , 1996, Journal of the American College of Cardiology.

[10]  J. Olgin,et al.  Atrial Macroreentry Involving the Myocardium of the Coronary Sinus: A Unique Mechanism for Atypical Flutter , 1998, Journal of cardiovascular electrophysiology.

[11]  A. Waldo Mechanisms of atrial flutter and atrial fibrillation: distinct entities or two sides of a coin? , 2002, Cardiovascular research.

[12]  K. Ellenbogen,et al.  Comparative efficacy of intravenous ibutilide versus procainamide for enhancing termination of atrial flutter by atrial overdrive pacing. , 1996, The American journal of cardiology.

[13]  F. Cosío,et al.  Validation of double-spike electrograms as markers of conduction delay or block in atrial flutter. , 1988, The American journal of cardiology.

[14]  J. Olgin,et al.  Conduction Barriers in Human Atrial Flutter: , 1996, Journal of cardiovascular electrophysiology.

[15]  J. Senges,et al.  Risk of thromboembolic events in patients with atrial flutter. , 1998, The American journal of cardiology.

[16]  A. Waldo,et al.  Role of Functional Block Extension in Lesion-Related Atrial Flutter , 2001, Circulation.

[17]  M. Scheinman,et al.  Right atrial flutter due to lower loop reentry: mechanism and anatomic substrates. , 1999, Circulation.

[18]  J. Triedman,et al.  Location of acutely successful radiofrequency catheter ablation of intraatrial reentrant tachycardia in patients with congenital heart disease. , 2000, The American journal of cardiology.

[19]  P. Grayburn,et al.  Prevalence of thrombus, spontaneous echo contrast, and atrial stunning in patients undergoing cardioversion of atrial flutter. A prospective study using transesophageal echocardiography. , 1997, Circulation.

[20]  L. Widman,et al.  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. , 1996, Circulation.

[21]  A. Waldo Atrial Flutter: , 1997, Journal of cardiovascular electrophysiology.

[22]  A. Capucci,et al.  Oral Propafenone To Convert Recent-Onset Atrial Fibrillation in Patients with and without Underlying Heart Disease , 1997, Annals of Internal Medicine.

[23]  F. Cosío,et al.  Fragmented electrograms and continuous electrical activity in atrial flutter. , 1986, The American journal of cardiology.

[24]  G. V. Van Hare,et al.  The atrial flutter reentrant circuit. Additional pieces of the puzzle. , 1996, Circulation.

[25]  J Clémenty,et al.  Mapping and ablation of left atrial flutters. , 2000, Circulation.

[26]  F. Cosío,et al.  Atrial Flutter Mapping and Ablation II. Radiofrequency Ablation of Atrial Flutter Circuits , 1996, Pacing and clinical electrophysiology : PACE.

[27]  H Ector,et al.  Ablation of post-surgical intra-atrial reentrant tachycardia. Predilection target sites and mapping approach. , 2002, European heart journal.

[28]  D. Shah,et al.  Dual-loop intra-atrial reentry in humans. , 2000, Circulation.

[29]  J. Thomas,et al.  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. , 1997, Journal of the American College of Cardiology.

[30]  Eugene H Blackstone,et al.  Atrial fibrillation: current surgical options and their assessment. , 2002, The Annals of thoracic surgery.

[31]  G. V. Van Hare,et al.  Mapping and radiofrequency ablation of intraatrial reentrant tachycardia after the Senning or Mustard procedure for transposition ofthe great arteries. , 1996, The American journal of cardiology.

[32]  Peng-Sheng Chen,et al.  Radiofrequency Catheter Ablation for the Treatment of Human Type 1 Atrial Flutter: Identification of a Critical Zone in the Reentrant Circuit by Endocardial Mapping Techniques , 1992, Circulation.

[33]  J. Jentzer Atrial Flutter: From Mechanism to Treatment , 2001 .

[34]  Z. Yuan,et al.  Risk of stroke in patients with atrial flutter. , 2001, The American journal of cardiology.

[35]  J. Triedman,et al.  Radiofrequency ablation of intra-atrial reentrant tachycardia after surgical palliation of congenital heart disease. , 1995, Circulation.

[36]  F. Cosío,et al.  Radiofrequency catheter ablation for the treatment of human type 1 atrial flutter. , 1993, Circulation.

[37]  J. Boineau,et al.  Left-sided atrial flutter: characterization of a novel complication of pediatric lung transplantation in an acute canine model. , 1996, The Journal of thoracic and cardiovascular surgery.

[38]  G. V. Van Hare,et al.  Importance of Atrial Flutter Isthmus in Postoperative Intra-Atrial Reentrant Tachycardia , 2000, Circulation.

[39]  M. Burke,et al.  Conduction Properties of the Inferior Vena Cava‐Tricuspid Annular Isthmus in Patients with Typical Atrial Flutter , 1997, Journal of cardiovascular electrophysiology.

[40]  A. Waldo,et al.  Demonstration of an area of slow conduction in atrial flutter , 1990 .

[41]  F. Morady,et al.  Acute changes in spontaneous echo contrast and atrial function after cardioversion of persistent atrial flutter. , 1998, The American journal of cardiology.

[42]  D. Wilber,et al.  Atypical atrial flutter originating in the right atrial free wall. , 2000, Circulation.

[43]  S. Gandhi,et al.  Atrial flutter: a newly recognized complication of pediatric lung transplantation. , 1996, The Journal of thoracic and cardiovascular surgery.

[44]  V. Fuster,et al.  ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conference , 2001, Circulation.

[45]  B. Drew,et al.  Risk of thromboembolism in chronic atrial flutter. , 1997, The American journal of cardiology.

[46]  F. Cosío,et al.  Atrial Flutter Mapping and Ablation I , 1996, Pacing and clinical electrophysiology : PACE.

[47]  F. Cosío,et al.  Radiofrequency ablation of the inferior vena cava-tricuspid valve isthmus in common atrial flutter. , 1993, The American journal of cardiology.

[48]  M. Scheinman,et al.  Acceleration of typical atrial flutter due to double-wave reentry induced by programmed electrical stimulation. , 1998, Circulation.

[49]  N. Saoudi,et al.  Catheter ablation of the atrial myocardium in human type I atrial flutter. , 1990, Circulation.

[50]  R. Page,et al.  Atypical Right Atrial Flutter Patterns , 2001, Circulation.

[51]  D. Shah,et al.  Radiofrequency Catheter Ablation of Common Atrial Flutter in 200 Patients , 1996, Journal of cardiovascular electrophysiology.