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European Heart Journal May 1998Atrial flutter is a specific electrical entity. It has a now well-established mechanism involving a single macro-re-entrant circuit. Whilst many patients with atrial... (Review)
Review
Atrial flutter is a specific electrical entity. It has a now well-established mechanism involving a single macro-re-entrant circuit. Whilst many patients with atrial flutter may develop atrial fibrillation, atrial flutter deserves its own recognition and requires specific management. Acute termination by drugs is possible, although adding pacing improves efficacy. Ibutilide is a new intravenous therapy with considerable efficacy by with a risk of torsade de pointes. For long-term control, radiofrequency ablation is gradually supplanting chronic oral antiarrhythmic strategies.
Topics: Anti-Arrhythmia Agents; Atrial Flutter; Cardiac Pacing, Artificial; Catheter Ablation; Electrocardiography; Heart Atria; Humans; Prognosis
PubMed: 9717023
DOI: No ID Found -
Polski Merkuriusz Lekarski : Organ... Jun 2020Atrial flutter (AFL) is one of the most common arrhythmias present in clinical practice, both for the GPs and cardiologist practice. After atrial fibrillation (AF) is... (Review)
Review
Atrial flutter (AFL) is one of the most common arrhythmias present in clinical practice, both for the GPs and cardiologist practice. After atrial fibrillation (AF) is second the most common supraventricular arrhythmia. This usually occurs along the cavo-tricuspid isthmus of the right atrium though atrial flutter can originate from the left atrium as well. As AFL is rarely susceptible to pharmacotherapy, that is why, the guidelines of the European and American Cardiology Societies suggest non-pharmacological treatment - an ablation, which is a "gold standard". Due to the reentrant nature of atrial flutter, it is often possible to ablate the circuit that causes atrial flutter with radiofrequency catheter ablation. Catheter ablation is considered to be a first-line treatment method for many people with typical atrial flutter due to its high rate of success (>90%) and low incidence of complications. This is done in the cardiac electrophysiology lab by causing a ridge of scar tissue in the cavo-tricuspid isthmus that crosses the path of the circuit that causes atrial flutter. Eliminating conduction through the isthmus prevents reentry, and if successful, prevents the recurrence of the atrial flutter. Atrial fibrillation often occurs after catheter ablation for atrial flutter. We present an up to date overview of the most important information about AFL based on the available literature.
Topics: Atrial Fibrillation; Atrial Flutter; Cardiology; Catheter Ablation; Electrocardiography; Heart Atria; Humans
PubMed: 32564048
DOI: No ID Found -
The Journal of Emergency Medicine 1988Atrial flutter is a supraventricular tachydysrhythmia believed to arise from electrophysiologic disturbances in the atria. It tends to be an unstable rhythm and is... (Review)
Review
Atrial flutter is a supraventricular tachydysrhythmia believed to arise from electrophysiologic disturbances in the atria. It tends to be an unstable rhythm and is usually associated with intrinsic cardiac or pulmonary disease or adverse extrinsic influences on the heart. It is due to either a reentry mechanism or an increased atrial automaticity. Atrial depolarization is regular at a rate of 260 to 340 beats per minute. With a normal atrioventricular (AV) node there is usually a physiologic second-degree block with resultant 2:1 conduction. Higher degrees of AV block can occur in patients with AV nodal disease, increased vagal tone, or when certain drugs are in use. One-to-one conduction may occur in patients with accessory AV nodal pathways. In this situation, serious adverse effects are often seen, including palpitations, dizziness, syncope, angina, and dyspnea. Electrical cardioversion is the safest and most reliable way of terminating atrial flutter and its use should not be delayed in an unstable patient. In the nonemergent situation a variety of medications alone or in combination can be used to convert the rhythm or slow ventricular response.
Topics: Atrial Flutter; Digoxin; Electric Countershock; Electrocardiography; Electrophysiology; Heart Conduction System; Humans; Verapamil
PubMed: 3283216
DOI: 10.1016/0736-4679(88)90252-1 -
Journal of Cardiovascular... Mar 1997Entrainment was first described based on observations during rapid (overdrive) pacing of type I atrial flutter. Entrainment is capture of the reentrant circuit of a... (Review)
Review
Entrainment was first described based on observations during rapid (overdrive) pacing of type I atrial flutter. Entrainment is capture of the reentrant circuit of a tachycardia without interrupting the tachycardia, so that with cessation of pacing, the spontaneous reentrant tachycardia is still present. During entrainment, the orthodromic wavefront from the pacing impulse resets the tachycardia to the pacing rate, while the antidromic wavefront either collides with the orthodromic wavefront of the previous beat (usual case) or is blocked by some other mechanism (refractoriness or another cause of block). Entrainment may be either manifest or concealed. The principles of entrainment during type I atrial flutter have permitted identification of targets for successful ablation, of mapping sites within or outside the reentrant circuit, and of appropriate pacing rates to successfully interrupt atrial flutter and restore sinus rhythm.
Topics: Animals; Atrial Flutter; Cardiac Pacing, Artificial; Catheter Ablation; Electrocardiography; Humans
PubMed: 9083885
DOI: 10.1111/j.1540-8167.1997.tb00798.x -
Pacing and Clinical Electrophysiology :... Dec 1992Atrial flutter is a common and usually benign but symptomatic supraventricular tachycardia. There is a striking similarity between patients with atrial flutter... (Review)
Review
Atrial flutter is a common and usually benign but symptomatic supraventricular tachycardia. There is a striking similarity between patients with atrial flutter suggesting a common substrate despite the presence or absence of underlying heart disease. In man, the mechanism is a single reentrant circuit originating in the right atrium whose center appears to be functional within the anatomical constraints of the right atrium. The reentrant circuit of atrial flutter contains an area of slow conduction in the inferior right atrium but the size and exact location is uncertain. Drug therapy directed at terminating and preventing atrial flutter has been available for many years. The efficacy and safety of this therapy is not as well tested as is the same therapy for atrial fibrillation. The most effective way to terminate atrial flutter is a nonpharmacological approach. Several nonpharmacological methods provide new treatment options in the management of patients with drug resistant or hemodynamically unstable atrial flutter. The use of anticoagulation for this disorder is still evolving. There is a risk of clinically apparent thromboemboli in some patients with atrial flutter although the risk appears less than that for atrial fibrillation. In the future, refinements and improvements in therapy for atrial flutter will likely be derived from a better understanding of its mechanism.
Topics: Animals; Anti-Arrhythmia Agents; Anticoagulants; Atrial Flutter; Atrial Function, Right; Cardiac Pacing, Artificial; Catheter Ablation; Electric Countershock; Electrocardiography; Heart Conduction System; Humans
PubMed: 1282252
DOI: 10.1111/j.1540-8159.1992.tb04174.x -
Journal of Cardiovascular... Mar 1997For five decades, the mechanism of atrial flutter remained controversial, with protagonists and antagonists of circus movement versus ectopic focus theories. The... (Review)
Review
For five decades, the mechanism of atrial flutter remained controversial, with protagonists and antagonists of circus movement versus ectopic focus theories. The development of clinical electrophysiology in the 1970s and the observations made by many authors in various canine heart models supported the concept of atrial flutter as a reentrant wave confined to the right atrium. It was established that, in the common type of atrial flutter, the activation wavefront proceeds in a cranial direction over the right atrial septum and descends on the right atrial free wall in the caudal direction. A zone of slow conduction was identified inferiorly and posteriorly in the right atrium, target of the modern ablative techniques. The history of atrial flutter clearly illustrates the bidirectional flow of information and the mutual stimulation between the basic and the clinical levels, leading both to a better understanding of the nature of the arrhythmia and to new therapeutic approaches.
Topics: Animals; Atrial Flutter; Dogs; Electrophysiology; History, 20th Century; Humans
PubMed: 9083886
DOI: 10.1111/j.1540-8167.1997.tb00799.x -
Annual Review of Medicine 1998Atrial flutter is a macroreentrant tachyarrhythmia most often contained within the right atrium. Typical atrial flutter is defined on an electrocardiogram by the classic... (Review)
Review
Atrial flutter is a macroreentrant tachyarrhythmia most often contained within the right atrium. Typical atrial flutter is defined on an electrocardiogram by the classic "sawtooth" pattern of flutter waves with negative polarity in leads II, III, and aVF. In contrast to atrial fibrillation, which is sustained by multiple reentrant wavelets defined by anatomic and/or functional barriers, typical atrial flutter is sustained by a single reentrant circuit defined by anatomical barriers. The isthmus of atrial tissue bordered by the inferior vena cava and the tricuspid annulus forms a critical zone of slow conduction in the reentry circuit of atrial flutter. The goal of radiofrequency catheter ablation is to create a line of conduction block across this isthmus. This line of block interrupts the flutter circuit and often provides long-term freedom from recurrence.
Topics: Atrial Fibrillation; Atrial Flutter; Atrioventricular Node; Catheter Ablation; Electrocardiography; Heart Atria; Humans; Recurrence; Tricuspid Valve; Vena Cava, Inferior
PubMed: 9509250
DOI: 10.1146/annurev.med.49.1.77 -
ESC Heart Failure Dec 2021While the interplay between heart failure (HF) and atrial fibrillation (AF) has been extensively studied, little is known regarding HF and atrial flutter (AFL), which... (Review)
Review
While the interplay between heart failure (HF) and atrial fibrillation (AF) has been extensively studied, little is known regarding HF and atrial flutter (AFL), which may be managed differently. We reviewed the incidence, prevalence, and predictors of HF in AFL and vice versa, and the outcomes of treatment of AFL in HF. A systematic literature review of PubMed/Medline and EMBASE yielded 65 studies for inclusion and qualitative synthesis. No study described the incidence or prevalence of AFL in unselected patients with HF. Most cohorts enrolled patients with AF/AFL as interchangeable diagnoses, or highly selected patients with tachycardia-induced cardiomyopathy. The prevalence of HF in AFL ranged from 6% to 56%. However, the phenotype of HF was never defined by left ventricular ejection fraction (LVEF). No studies reported the predictors, phenotype, and prognostic implications of AFL in HF. There was significant variation in treatments studied, including the proportion that underwent ablation. When systolic dysfunction was tachycardia-mediated, catheter ablation demonstrated LVEF normalization in up to 88%, as well as reduced cardiovascular mortality. In summary, AFL and HF often coexist but are understudied, with no randomized trial data to inform care. Further research is warranted to define the epidemiology and establish optimal management.
Topics: Atrial Flutter; Catheter Ablation; Heart Failure; Humans; Stroke Volume; Ventricular Function, Left
PubMed: 34505352
DOI: 10.1002/ehf2.13526 -
Heart Rhythm Jul 2021
Review
Topics: Atrial Flutter; Body Surface Potential Mapping; Catheter Ablation; Heart Atria; Humans; Tachycardia, Atrioventricular Nodal Reentry
PubMed: 33845215
DOI: 10.1016/j.hrthm.2021.04.005 -
The Turkish Journal of Pediatrics 2018Yılmaz-Semerci S, Bornaun H, Kurnaz D, Cebeci B, Babayiğit A, Büyükkale G, Çetinkaya M. Neonatal atrial flutter: Three cases and review of the literature. Turk J... (Review)
Review
Yılmaz-Semerci S, Bornaun H, Kurnaz D, Cebeci B, Babayiğit A, Büyükkale G, Çetinkaya M. Neonatal atrial flutter: Three cases and review of the literature. Turk J Pediatr 2018; 60: 306-309. Atrial flutter (AFl) is known to be a seldom type of fetal and neonatal arrhythmia. Although it could end in severe morbidities such as hydrops fetalis or even death, with early prenatal diagnosis and prompt therapeutic approaches the majority of AFl cases show good prognosis. Neonatal AFl might be resistant to first step therapies. Therefore, secondary agents like flecainide, amiodarone, sotalol and cardioversion, if required, could be influent in perinatal tachyarrhythmia. In addition, close follow-up even after discharge is very important to keep all follow-up appointments. Herein, we present three cases of fetal/neonatal AFl in light of the literature and discuss the characteristics, diagnosis and treatment options.
Topics: Anti-Arrhythmia Agents; Atrial Flutter; Electric Countershock; Electrocardiography; Female; Humans; Infant, Newborn; Male; Pregnancy; Ultrasonography, Prenatal
PubMed: 30511544
DOI: 10.24953/turkjped.2018.03.011