Surface electrocardiographic characteristics of right and left atrial flutter
Abstract
BACKGROUND: There is little information about the surface expression of non-cavotricuspid isthmus (CTI)-dependent right atrial (RA) or left atrial (LA) flutter circuits. METHODS AND RESULTS: We retrospectively evaluated 32 episodes (in 26 patients) of atypical RA and 22 episodes (in 21 patients) of LA flutter. The surface ECG of 13 patients with lower-loop reentry was similar to that of their pattern during counterclockwise (CCW) CTI atrial flutter (AFL), except for decreased amplitude of the terminal forces in the inferior leads. In 11 of 24 episodes characterized by high or multiple breaks over the crista, the ECG showed changes that depended on the initial activation sequence of the LA. In 7 of 8 episodes of upper-loop reentry, the ECG pattern completely mimicked that for clockwise (CW) CTI AFL. All 11 patients with an LA septal circuit showed a typical ECG pattern characterized by prominent forces in lead V1 with flat deflections in the other surface leads. Eleven patients with other LA circuits had a more variable pattern but showed decreased voltage in the inferior leads compared with that of a group with CCW-CTI AFL (1.6+/-1 vs 2.68+/-0.7 mV, respectively; P<0.05). CONCLUSIONS: The RA surface-ECG patterns different from those of CCW or CW-CTI could still be CTI dependent. In contrast, a typical CW-CTI surface pattern was always seen in patients with upper-loop reentry, which was non-CTI dependent. LA AFL circuits had either flat or low-amplitude forces in the inferior leads.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In scar-related areas of block, the ECG pattern may not be typical, and conversely a typical AFL ECG may be produced by atypical MRT even due to LA circuits.
“In these cases with scar-related areas of block the ECG pattern may not Table 12 Therapy of atrial flutter/ macro-reentrant tachycardia Recommendation Reference Acute therapy Synchronised DC cardioversion is recommended for haemodynamically unstable patients with AFL/MRT a 131,132 IV anticoagulation may be considered in case emergency cardioversion is necessary.Anticoagulation should be continued”
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 [171]
The ECG pattern of atypical flutter is difficult to relate to its mechanism because slow conduction segments in reentry pathways can produce isoelectric lines and atrial waves may reflect activation outside the circuit.
“The ECG pattern is difficult to relate to the mechanism, since slow conduction segments in reentry pathways may produce isoelectric lines and the atrial waves may reflect activation outside the circuit.171”
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 [171]
Cites
Mapping and ablation of left atrial flutters
Jaïs, P., Shah, D. C., Haïssaguerre, M., Hocini, M., Peng, J. T., Takahashi, A., Garrigue, S., Le Métayer, P., & Clémenty, J. (2000) · Circulation · doi:10.1161/01.cir.101.25.2928 · Cited by 380 · see citing works
Right Atrial Flutter Due to Lower Loop Reentry: Mechanism and Anatomic Substrates
Cheng, J., Cabeen, W. R., & Scheinman, M. M. (1999) · Circulation · doi:10.1161/01.cir.99.13.1700 · Cited by 152 · see citing works
Electrocardiographic and Electrophysiologic Characterization of Atypical Atrial Flutter in Man:
Kalman, J. M., Olgin, J. E., Saxon, L. A., Lee, R. J., Scheinman, M. M., & Lesh, M. D. (1997) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.1997.tb00775.x · Cited by 139 · see citing works
Self-citationAtypical Right Atrial Flutter Patterns
Yang, Y., Cheng, J., Bochoeyer, A., Hamdan, M. H., Kowal, R. C., Page, R. L., Lee, R. J., Steiner, P. R., Saxon, L. A., Lesh, M. D., et al. (2001) · Circulation · doi:10.1161/01.cir.103.25.3092 · Cited by 128 · see citing works
Self-citationOkumura, K., Plumb, V. J., Pagé, P., & Waldo, A. L. (1991) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(10)80124-x · Cited by 121 · see citing works
Friedman, P. A., Luria, D., Fenton, A. M., Munger, T. M., Jahangir, A., Shen, W. K., Rea, R. F., Stanton, M. S., Hammill, S. C., & Packer, D. L. (2000) · Circulation · doi:10.1161/01.cir.101.13.1568 · Cited by 117 · see citing works
Atypical atrial flutter originating in the right atrial free wall
Kall, J. G., Rubenstein, D. S., Kopp, D. E., Burke, M. C., Verdino, R. J., Lin, A. C., Johnson, C. T., Cooke, P. A., Wang, Z. G., Fumo, M., et al. (2000) · Circulation · doi:10.1161/01.cir.101.3.270 · Cited by 105 · see citing works
Saoudi, N. C., Nair, M., ABDELAZZIZ, A., Poty, H., Daou, A., Anselme, F., & Letac, B. (1996) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.1996.tb00467.x · Cited by 92 · see citing works
TAI, C., Huang, J., Lin, Y., HSIEH, M., Lee, P.-C., Ding, Y.-A., Chang, M.-S., & Chen, S. (2002) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(02)02036-3 · Cited by 86 · see citing works
Biatrial Activation in Isthmus-Dependent Atrial Flutter
Rodriguez, L., Timmermans, C. C., Nabar, A., Hofstra, L., & Wellens, H. J. J. (2001) · Circulation · doi:10.1161/hc4601.097996 · Cited by 66 · see citing works
Cheng, J., & Scheinman, M. M. (1998) · Circulation · doi:10.1161/01.cir.97.16.1589 · Cited by 60 · see citing works
Self-citationSippensgroenewegen, A., Lesh, M. D., Roithinger, F. X., et al. (2000) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(00)00549-0 · Cited by 51 · see citing works
Circus movement atrial flutter in the canine sterile pericarditis model
Schoels, W., Offner, B., Brachmann, J., Kübler, W., & El-Sherif, N. (1994) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(94)90771-4 · Cited by 45 · see citing works
Ndrepepa, G., Zrenner, B., Deisenhofer, I., KARCH, M. R., Schneider, M., Schreieck, J., & Schmitt, C. (2000) · Zeitschrift für Kardiologie · doi:10.1007/s003920070225 · Cited by 41 · see citing works
New Insights Regarding the Atrial Flutter Reentrant Circuit
Uno, K., Kumagai, K., Khrestian, C. M., & Waldo, A. L. (1999) · Circulation · doi:10.1161/01.cir.100.12.1354 · Cited by 39 · see citing works
Physiology of Atrial Pacemakers and Conductive Tissues.
(1981) · Annals of Internal Medicine · doi:10.7326/0003-4819-94-3-420_3 · Cited by 36 · see citing works
Activation Patterns in the Left Atrium During Counterclockwise and Clockwise Atrial Flutter
Ndrepepa, G., Zrenner, B., Weyerbrock, S., Schneider, M., & Schmitt, C. (2001) · Journal of Cardiovascular Electrophysiology · doi:10.1046/j.1540-8167.2001.00893.x · Cited by 22 · see citing works
Mechanisms and Clinical Implications of Atypical Atrial Flutter
Scheinman, M. M., Cheng, J., & Yang, Y. (1999) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.1999.tb00288.x · Cited by 16 · see citing works
Self-citationUncommon Atrial Flutter: Characteristics, Mechanisms, and Results of Ablative Therapy
Gomes, J. A., Santoni‐Rugiu, F., Mehta, D., et al. (1998) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.1998.tb01121.x · Cited by 15 · see citing works
Electrophysiologic Study and Radiofrequency Catheter Ablation of Isthmus‐Independent Atrial Flutter
Lai, L., Lin, J.-L., Tseng, C.-D., et al. (1999) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.1999.tb00249.x · Cited by 5 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Mechanisms of organized left atrial tachycardias occurring after pulmonary vein isolation
Gerstenfeld, E. P., Callans, D. J., Dixit, S., Russo, A. M., Nayak, H., Lin, D., Pulliam, W., Siddique, S., & Marchlinski, F. E. (2004) · Circulation · doi:10.1161/01.cir.0000141369.50476.d3 · Cited by 300 · see citing works
Katritsis, D. G., Boriani, G., Cosio, F. G., Hindricks, G., Jaïs, P., Josephson, M. E., Keegan, R., Kim, Y.-H., Knight, B. P., Kuck, K.-H., et al. (2017) · Europace · doi:10.1093/europace/euw301 · Cited by 188 · see citing works
Atrial flutter: more than just one of a kind
Bun, S.-S., Latcu, D. G., Marchlinski, F., & Saoudi, N. (2015) · European Heart Journal · doi:10.1093/eurheartj/ehv118 · Cited by 115 · see citing works
TAKAHASHI, Y., TAKAHASHI, A., MIYAZAKI, S., KUWAHARA, T., TAKEI, A., FUJINO, T., FUJII, A., KUSA, S., YAGISHITA, A., NOZATO, T., et al. (2009) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2008.01410.x · Cited by 54 · see citing works
Santucci, P. A., Varma, N., Cytron, J., Akar, J. G., Wilber, D. J., Al Chekakie, M. O., & Brysiewicz, N. (2009) · Heart Rhythm · doi:10.1016/j.hrthm.2009.08.010 · Cited by 42 · see citing works
AKAR, J. G., AL‐CHEKAKIE, M. O., HAI, A., BRYSIEWICZ, N., PORTER, M., VARMA, N., SANTUCCI, P., & WILBER, D. J. (2007) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2007.00761.x · Cited by 36 · see citing works
- Authors
- Bochoeyer, A., Yang, Y., Cheng, J., Lee, R. J., Keung, E. C., Marrouche, N. F., Natale, A., & Scheinman, M. M.
- Affiliations
- *Drs Bochoeyer and Yang are co-first authors.
- San Francisco VA Medical Center (US)
- Venue
- Circulation
- Published
- 2003-07-08
- Volume
- 108
- Issue
- 1
- Pages
- 60-66
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W1972673621
- Cited by
- 123
- References
- 20
- Citations by year
- 2025: 4 · 2024: 6 · 2023: 1 · 2022: 2 · 2021: 7 · 2020: 2 · 2019: 13 · 2018: 4 · 2017: 8 · 2016: 1 · 2015: 3 · 2014: 5 · 2013: 3 · 2012: 5
- FWCI
- 5.93
- 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 › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Keywords
- atrial flutter, right atrial flutter, left atrial flutter, inferior leads, crista terminalis
- MeSH terms
- Aged, Atrial Flutter, Electrocardiography, Female, Heart Atria, Humans, Male, Middle Aged, Retrospective Studies, Sensitivity and Specificity, Catheter Ablation, Body Surface Potential Mapping, Electrophysiologic Techniques, Cardiac
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
