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. 2000 Aug;84(2):227–232. doi: 10.1136/heart.84.2.227

Treatment of atrial flutter

A Waldo 1
PMCID: PMC1760909  PMID: 10908269

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Figure 1:  .

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Left: atrial activation in typical atrial flutter (AFL). Right: activation in reverse typical AFL. The atria are represented schematically in a left anterior oblique view, from the tricuspid (left) and mitral rings. The endocardium is shaded and the openings of the superior (SVC) and inferior vena cava (IVC), coronary sinus (CS), and pulmonary veins (PV) are shown. The direction of activation is shown by arrows. Dashed areas mark approximate location of zones of slow conduction and block. Lettering on the right hand panel marks the low (LPS), mid (MPS), and high (HPS) posteroseptal wall, respectively. Modified after Cosío FG et al. J Cardiovasc Electrophysiol 1996;7:60-70.

Figure 2:  .

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A 12 lead ECG in a case of typical type I atrial flutter. The atrial rate is 300 bpm and the ventricular rate is 150 bpm; 2:1 AV block is present. Note that the atrial activity is best seen in leads II, III, and aVF and is barely perceptible in lead I. Reproduced with permission from Waldo AL, Kastor JA: Atrial flutter. In: Kastor JA, ed. Arrhythmias. Philadelphia: WB Saunders Co, 1994:105-15.

Figure 3:  .

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12 lead ECG from a patient with reverse typical atrial flutter confirmed at electrophysiological study. The atrial rate is 266 bpm with 2:1 AV conduction. Note the positive flutter waves in leads II, III, and aVF, and the negative flutter waves in lead V1. Reproduced courtesy of N Varma, MD.

Figure 4:  .

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ECG lead II recorded from a patient with typical atrial flutter (spontaneous atrial cycle length of 264 ms). Rapid atrial pacing from a high right atrial site at a cycle length of 254 ms (not shown), at a cycle length of 242 ms (not shown), and at a cycle length of 232 ms (not shown) failed to terminate the atrial flutter. Panel A shows ECG lead II recorded during high right atrial pacing at a cycle length of 224 ms. Note that with the seventh atrial beat in this tracing, and after 22 seconds of atrial pacing at a constant rate, the atrial complexes suddenly became positive. Panel B shows ECG lead II recorded at the termination of atrial pacing in the same patient. Note that with abrupt termination of pacing, sinus rhythm occurs. In panel C, the first beat (asterisk) is identical to the last beat in panel B (asterisk). S, stimulus artifact. Time lines are at 1 second intervals. Modified from Waldo AL, et al. Circulation 1997;56:737-45.

Figure 5:  .

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Targets for typical or reverse typical atrial flutter ablation. The schematic drawing shows the atria in an anterior view. The endocardium, inside the tricuspid (left) and mitral (right) rings, is shaded. The openings of the inferior vena cava (IVC), coronary sinus (CS), and left pulmonary veins (PV) are shown in black. Long arrows show activation sequence in common atrial flutter. The striped areas (large open arrows) mark ablation targets: 1, IVC-tricuspid valve isthmus; 2, CS-tricuspid valve isthmus; 3, CS-IVC isthmus. SVC, superior vena cava. Reproduced with permission from Cosío et al.19

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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