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Atrial flutter ablation location12/6/2023 ![]() Furthermore, the development of atrial mapping has also led to a better definition of the electrophysiological mechanisms of atypical atrial flutter. By contrast, in type I atypical flutter, the macro-re-entrant circuit in the right atrium proceeds in a clockwise direction ( 1– 13). Subsequent electrophysiological studies with mapping of the right atrium have demonstrated that type I typical flutter is caused by a macro-re-entrant circuit in the right atrium, which proceeds in a counterclockwise direction. By contrast, type II atrial flutter had a faster atrial rate, between 340 and 430 b.p.m., and could not be interrupted with overdrive atrial pacing. and could be interrupted with overdrive atrial pacing. Type I atrial flutter had an atrial rate of 240–340 b.p.m. Therefore, atrial flutter was divided into types I and II. In 1977, Waldo et al ( 8) developed another classification of atrial flutter, mainly based on the atrial rate and on the possibility of interrupting arrhythmia with atrial pacing. Impure flutter was defined as a transitional pattern between atrial flutter and atrial fibrillation, with an atrial rate > 320 b.p.m. In the atypical form, F waves were positive in inferior leads and V6, with the same rate as common atrial flutter. In the common form, there were predominantly negative F waves in inferior leads (II, III and aVF) and V6, with an atrial rate ranging from 250 to 330 b.p.m. The authors classified atrial flutter as common (or typical), atypical and impure flutter. The first classification of atrial flutter was developed in 1970 by Puech et al ( 7) on the basis of the morphology of flutter waves on surface ECG. The surface 12-lead ECG is helpful in establishing a diagnosis of atrial flutter at least for the common form due to counterclockwise reentry in the right atrium and the uncommon form with reverse activation sequence ( 4– 6). The atrial rhythm, during atrial flutter, is regular (250–350 beats/min) with little or no isoelectric interval on the ECG. The development of clinical electrophysiology in the 1970s and the observations made by many authors in various canine heart models supported the concept that flutter is a macro-re-entrant arrhythmia, often determined by a re-entrant circuit confined to the right atrium ( 1– 3). For five decades the mechanism of atrial flutter remained controversial with protagonists and antagonists of circus movement versus ectopic focus theories. The authors worked out a new terminology, which differentiates atrial flutter only on the basis of electrophysiological mechanism.Ītrial flutter is a common arrhythmia that may cause significant symptoms, including palpitations, dyspnea, chest pain and even syncope. The terms like common, uncommon, typical, reverse typical or atypical flutter are abandoned because they may generate confusion. More recently, Scheinman et al, provided an updated classification and nomenclature. New developments in endocardial mapping, including the electroanatomical 3D mapping system, have greatly expanded our understanding of the mechanism of arrhythmias. Therefore, in 2001 the European Society of Cardiology and the North American Society of Pacing and Electrophysiology developed a new classification of atrial flutter, based not only on the ECG, but also on the electrophysiological mechanism. These authors divided the arrhythmia into type I and type II. Puech and Waldo developed the first classification of atrial flutter in the 1970s. Frequently it’s possible to diagnose atrial flutter with a 12-lead surface ECG, looking for distinctive waves in leads II, III, aVF, aVL, V1,V2. ![]() Atrial flutter is a common arrhythmia that may cause significant symptoms, including palpitations, dyspnea, chest pain and even syncope.
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