Atrial Flutter Mapping and Ablation I: Studying Atrial Flutter Mechanisms by Mapping and Entrainment
Abstract
Endocardial mapping has led to a detailed knowledge of reentry mechanisms in atrial flutter. Multipolar and deflecting tip catheters allow recording local electrograms from multiple areas of the right atrium, and from the coronary sinus. In common flutter, with the typical "sawtooth" pattern, there is circular activation of the right atrium in a "counterclockwise" direction, descending in the anterior and lateral walls, and ascending in the septum and posterior wall. Superior and inferior vena cava, linked by a "line" of functional block in the posterolateral wall, make the central obstacle for circular activation. The cranial and caudal turning points are the atrial "roof," and the isthmus between the inferior vena cava and the tricuspid valve. Complex conduction patterns, probably including slow conduction are detectable in the low septal area, around the coronary sinus. Atypical flutter, without the sharp negative deflections of common flutter, sometimes shows circular activation in the right atrium, rotating in the opposite direction of common flutter (clockwise). Other atypical flutters show no circular right atrial activation, and only partial data from coronary sinus activation, combined with the response to atrial stimulation (entrainment) allow the diagnosis of left atrial reentry, without a precise delimitation of the circuits. In patients having undergone cardiac surgery, atypical flutter may be based on reentry around surgical scars. To our knowledge, the mechanism of type II flutter has not been disclosed in humans.
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Atrial mapping studies have identified the mechanism of typical AFL as a macroreentrant circuit contained in the right atrium with passive activation of the left atrium.
“Atrial mapping studies have identified the mechanism of typical AFL as a macroreentrant circuit contained in the right atrium (RA) with passive activation of the left atrium (Figure 11).122”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [122]
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Lone Atrial Flutter in Children and Adolescents: Is It Really “Lone”?
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Current Concepts and Management Strategies in Atrial Flutter
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A Case of Widely Split Double P Waves with Marked Intra‐Atrial Conduction Delay
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Supraventricular and Ventricular Arrhythmias
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Caracterización electrofisiológica y clínica de la taquicardia macrorreentrante auricular izquierda
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Catheter ablation of atrial fibrillation
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Pathophysiology of Typical Atrial Flutter
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Electrophysiological Properties of the Right Atrial Septum in Patients with Atrial Tachyarrhythmias
Yamaguchi, N., Kumagai, K., Fukuda, K., Wakayama, Y., Sugai, Y., Hirose, M., & Shimokawa, H. (2008) · The Tohoku Journal of Experimental Medicine · doi:10.1620/tjem.215.13 · Cited by 4 · see citing works
García‐Seara, J., Gudé, F., Cabanas‐Grandío, P., Martínez‐Sande, J. L., Fernández-López, X. A., Elices‐Teja, J., Raposeiras‐Roubín, S., & González‐Juanatey, J. R. (2012) · Revista Española de Cardiología · doi:10.1016/j.recesp.2012.03.028 · Cited by 4 · see citing works
Atrial and ventricular tachyarrhythmias in military personnel
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Radiofrequency ablation of atrial tachycardia and atrial flutter
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Self-citationGarcía-Cosío, F., Pastor, A., & Núñez, A. (1999) · Revista Española de Cardiología · doi:10.1016/s0300-8932(99)74904-3 · Cited by 4 · see citing works
Improved Flutter Ablation Outcomes Using a 10mm-tip Ablation Catheter.
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Learning by Burning in Atrial Fibrillation: An Uncertain, Complicated Quest
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Katheterablation von isthmusabhängigem Vorhofflattern
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Atrial Flutter Ablation: Long-Term Results with Standard Approach after Eight Years of Experience
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Self-citationGap Junctions, Cardiac Excitability and Clinical Arrhythmias
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Oral d,l-sotalol in atrial fibrillation and/or flutter
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Arnaud, M., Sacristan, B., Hocini, M., Jaı̈s, P., Haı̈ssaguerre, M., & Duchâteau, J. (2024) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2024.1494836 · Cited by 2 · see citing works
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Antithrombotic therapy in atrial flutter: To anticoagulate or not, that is the question
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García‐Seara, J., Gudé, F., Cabanas‐Grandío, P., Martínez‐Sande, J. L., López, X. F., Hernández‐Madrid, A., Moro, C., & González‐Juanatey, J. R. (2012) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-10-90 · Cited by 2 · see citing works
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Katheterablation von Vorhofflattern
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Clinical Cardiac Electrophysiology: An Overview of Its Evolution
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Ablación endocárdica del sustrato de taquicardia ventricular postinfarto durante ritmo sinusal
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Self-citationHelical Representation of Atrial Reentry: A Teaching Aid for Electrophysiology
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Catheter Ablation of Supraventricular and Ventricular Arrhythmias
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Treatment of Cardiac Arrhythmias
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Die Ablation ist die Therapie der Wahl bei typischem Vorhofflattern
Gwechenberger, M. (2014) · Journal für Kardiologie (Krause & Pachernegg GmbH)
Mechanical Modulation of a Reentrant Arrhythmia: The Atrial Flutter Case
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Endocavitary Treatment of Atrial Fibrillation
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Feld, G. K. (2000) · Developments in cardiovascular medicine · doi:10.1007/978-0-585-28007-3_1
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- Authors
- COSIO, F. G., ARRIBAS, F., LÓPEZ‐GIL, M., & PALACIOS, J.
- Affiliations
- Hospital Universitario 12 De Octubre (ES)
- Venue
- Pacing and Clinical Electrophysiology
- Publisher
- Wiley
- Published
- 1996-05
- Volume
- 19
- Issue
- 5
- Pages
- 841-853
- ISSN
- 0147-8389 (ISSN-L)
- 1540-8159
- OpenAlex
- W1573969966
- Cited by
- 111
- References
- 37
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 3 · 2022: 1 · 2021: 2 · 2020: 3 · 2019: 1 · 2017: 1 · 2016: 1 · 2015: 2 · 2014: 1 · 2013: 1 · 2012: 6
- FWCI
- 2.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pacing and Clinical Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Keywords
- atrial flutter, endocardial mapping, catheter ablation, reentry mechanism, coronary sinus electrogram, inferior vena cava, atrial stimulation
- MeSH terms
- Atrial Flutter, Cicatrix, Coronary Vessels, Electrocardiography, Heart Atria, Heart Septum, Cardiac Surgical Procedures, Humans, Cardiomyopathies, Neural Conduction, Tricuspid Valve, Vena Cava, Inferior, Vena Cava, Superior, Catheter Ablation, Body Surface Potential Mapping
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