Contemporary management of atrial flutter
Abstract
A 60-year-old dentist presents to the emergency room with palpitations for 3 hours.The ECG shows atrial flutter (AFl) with atrioventricular (AV) conduction varying from 2:1 to 4:1.He has known hypertension for which he takes 10 mg of enalapril daily.In the last 2 years he was seen twice because of AFl and on both occasions 1 mg of ibutilide IV resulted in the return of sinus rhythm with 1:1 AV conduction.Catheter ablation of the arrhythmia is discussed with the patient, to which he agrees and curative AFl ablation is scheduled in 4 weeks. HistoryIn 1906, Einthoven made an electrocardiographic recording of AFl. 1 In 1913, Lewis called attention to the typical saw tooth pattern and the negative deflections of the atrial waves in leads II and III. 2 During the next 50 years, there was much discussion about whether AFl was caused by a rapidly firing atrial focus or is the result of a large circus movement involving the atria.After mapping atrial activation with endocardial and esophageal recordings, Puech et al 3 concluded that the flutter cycle in the human heart involved activation of the whole right atrium.Stimulation studies by Waldo et al 4 revealed that in postoperative AFl the arrhythmia was based on a reentry mechanism involving a large atrial area.They demonstrated the presence of an excitable gap that allowed the speeding up of the flutter rate during atrial pacing and termination of the arrhythmia by pacing.
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The goals for the management of atrial flutter are similar to those for AF.
“The goals for the management of atrial flutter are similar to those for AF.992”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [992]
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- Authors
- Wellens, H. J. J.
- Affiliations
- Netherlands Heart Institute (NL)
- Corresponding author
- Wellens, Hein J.J.
- Venue
- Circulation
- Published
- 2002-08-06
- Volume
- 106
- Issue
- 6
- Pages
- 649-652
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2108174487
- Cited by
- 87
- References
- 29
- Citations by year
- 2024: 3 · 2023: 7 · 2022: 4 · 2021: 1 · 2020: 3 · 2019: 4 · 2018: 4 · 2017: 4 · 2016: 6 · 2015: 4 · 2014: 2 · 2013: 4 · 2012: 2
- FWCI
- 2.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atrial flutter, catheter ablation, ibutilide, atrioventricular conduction, reentry mechanism, excitable gap, atrial activation mapping, palpitations, hypertension
- MeSH terms
- Anti-Arrhythmia Agents, Anticoagulants, Atrial Fibrillation, Atrial Flutter, Cardiac Pacing, Artificial, Electric Countershock, Electrocardiography, Humans, Male, Middle Aged, Models, Cardiovascular, Tachycardia, Supraventricular, Catheter Ablation
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