Cited by 87Cardiac Arrhythmias and TreatmentsAtrial Fibrillation Management and OutcomesCardiac electrophysiology and arrhythmias

Contemporary management of atrial flutter

Wellens, Hein J.J.·2002·Circulation

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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Crossref · 10.1161/01.cir.0000027683.00417.9a

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Research works printed but not linked: 7

  1. Einthoven W. The telecardiogramme. Arch Internat Physiol. 1906;4: 132-141.
  2. Lewis T. Observations upon a curious and not uncommon form of extreme acceleration of the auricle: atrial flutter. Heart. 1913;4:171-178.
  3. Puech P, Latour H, Grolleau R. Le flutter et ses limites. Arch Mal Coeur. 1970;61:116 -124.
  4. Bialy D, Lehman MH. Hospitalization for arrhythmias in the United States: importance of atrial fibrillation. J Am Coll Cardiol. 1992;19:716. Abstract.
  5. Volgman AS, Carberry PA, Stambler B, et al. Conversion efficacy and safety of intravenous ibutilide compared with intravenous procainamide in patients with atrial flutter or fibrillation. J Am Coll Cardiol. 1998;31:1414-1419.
  6. Macaluso G, Cornet B, Bouvier JL, et al. Marqueurs biochimiques de souffrance myocardique apres ablation de flutter auriculaire par radio- frequence de haute energie. Interet de la troponine I. Arch Mal Cœur. 2002;95:102-108.
  7. Tai CT, Chen SA, Chiang CE, et al. Long term outcome of radiofre- quency catheter ablation for typical atrial flutter: risk prediction of recurrent arrhythmias. J Cardiovasc Electrophysiol. 1998;115:121.

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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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