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Journal of the American College of... Feb 2008There is a close interrelationship between atrial fibrillation (AF) and atrial flutter (AFL). Atrial fibrillation of variable duration precedes the onset of AFL in... (Review)
Review
There is a close interrelationship between atrial fibrillation (AF) and atrial flutter (AFL). Atrial fibrillation of variable duration precedes the onset of AFL in almost all instances; during AF, the functional components needed to complete the AFL re-entrant circuit, principally a line of block (LoB) between the vena cavae, are formed; if this LoB does not form, classical AFL does not develop. In contrast, there seems to be a spectrum of atrial re-entrant circuits (drivers) of short cycle lengths (CLs) (i.e., AFL). When the CL of the AFL re-entrant circuit is so short that it will only activate portions of the atria in a 1:1 manner, the rest of the atria will be activated rapidly but irregularly (i.e., via fibrillatory conduction), resulting in AF. In short, there are probably several mechanisms of AF, 1 of which is due to a very rapid AFL causing fibrillatory conduction. All of these interactions of AF and AFL have important clinical implications.
Topics: Animals; Atrial Fibrillation; Atrial Flutter; Humans
PubMed: 18294560
DOI: 10.1016/j.jacc.2007.08.066 -
Heart Rhythm Jan 2016Few epidemiologic cohort studies have evaluated atrial flutter (flutter) as an arrhythmia distinct from atrial fibrillation (AF).
BACKGROUND
Few epidemiologic cohort studies have evaluated atrial flutter (flutter) as an arrhythmia distinct from atrial fibrillation (AF).
OBJECTIVE
The purpose of this study was to examine the clinical correlates of flutter and its associated outcomes to distinguish them from those associated with AF in the Framingham Heart Study.
METHODS
We reviewed and adjudicated electrocardiograms (ECGs) previously classified as flutter or AF/flutter and another 100 ECGs randomly selected from AF cases. We examined the clinical correlates of flutter by matching up to 5 AF and 5 referents to each flutter case using a nested case referent design. We determined the 10-year outcomes associated with flutter with Cox models.
RESULTS
During mean follow-up of 33.0 ± 12.2 years, 112 participants (mean age 72 ± 10 years, 30% women) developed flutter. In multivariable analyses, smoking (odds ratio [OR] 2.84, 95% confidence interval [CI] 1.54-5.23), increased PR interval (OR 1.28 per SD, 95% CI 1.03-1.60), myocardial infarction (OR 2.25, 95% CI 1.05-4.80) and heart failure (OR 5.22, 95% CI 1.26-21.64) were associated with incident flutter. In age- and sex-adjusted models, flutter (vs referents) was associated with 10-year increased risk of AF (hazard ratio [HR] 5.01, 95% CI 3.14-7.99), myocardial infarction (HR 3.05, 95% CI 1.42-6.59), heart failure (HR 4.14, 95% CI 1.90-8.99), stroke (HR 2.17, 95% CI 1.13-4.17), and mortality (HR 2.00, 95% CI 1.44-2.79).
CONCLUSION
We identified the clinical correlates associated with flutter and observed that flutter was associated with multiple adverse outcomes.
Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Atrial Flutter; Cohort Studies; Diagnosis, Differential; Electrocardiography; Female; Heart Failure; Humans; Longitudinal Studies; Male; Middle Aged; Myocardial Infarction; Outcome Assessment, Health Care; Prognosis; Risk Factors; Stroke
PubMed: 26226213
DOI: 10.1016/j.hrthm.2015.07.031 -
Journal of the American Heart... Sep 2023Background Atrial fibrillation (AF) and atrial flutter (AFL) are common conditions that can lead to significant morbidity and death. We aimed to understand the...
Background Atrial fibrillation (AF) and atrial flutter (AFL) are common conditions that can lead to significant morbidity and death. We aimed to understand the distribution and disparities of the global burden of AF/AFL as well as the underlying risk factors. Methods and Results Data on the AF/AFL burden from the Global Burden of Disease data set were analyzed for the years 1990 to 2019, with countries grouped into low, lower-middle, upper-middle, and high national income classes according to World Bank categories. Data were supplemented with World Health Organization and World Bank information. The prevalence of AF/AFL has more than doubled (+120.7%) since 1990 in all income groups, though with a larger increment in middle-income countries (+146.6% in lower-middle- and +145.2% in upper-middle-income countries). In absolute numbers, 63.4% of AF/AFL cases originate from upper-middle-income countries, although the relative prevalence is highest in high-income countries. Prevalence of AF/AFL appears to be correlated with medical doctor rate and life expectancy. The most relevant AF/AFL risk factors are unevenly distributed among income classes, with elevated blood pressure as the only risk factor that becomes less common with increasing income. The development of these risk factors differed over time. Conclusions The global burden of AF/AFL is increasing in all income groups and is more pronounced in middle-income countries, with further growth to be expected. Underdiagnosis of AF/AFL in low- and middle-income countries may contribute to lower reported prevalence. The risk factor distribution varies between income groups.
Topics: Humans; Atrial Fibrillation; Global Burden of Disease; Atrial Flutter; Dietary Supplements; Hypertension
PubMed: 37646216
DOI: 10.1161/JAHA.123.030438 -
Internal Medicine (Tokyo, Japan) Nov 2021
Topics: Atrial Fibrillation; Atrial Flutter; Atrioventricular Block; Electrocardiography; Humans
PubMed: 33994443
DOI: 10.2169/internalmedicine.7514-21 -
European Heart Journal. Cardiovascular... Dec 2021Atrial arrhythmias, including atrial fibrillation and atrial flutter, may be treated through catheter ablation. The process of atrial arrhythmia catheter ablation, which... (Review)
Review
Atrial arrhythmias, including atrial fibrillation and atrial flutter, may be treated through catheter ablation. The process of atrial arrhythmia catheter ablation, which includes patient selection, pre-procedural planning, intra-procedural guidance, and post-procedural assessment, is typically characterized by the use of several imaging modalities to sequentially inform key clinical decisions. Increasingly, advanced imaging modalities are processed via specialized image analysis techniques and combined with intra-procedural electrical measurements to inform treatment approaches. Here, we review the use of multimodality imaging for left atrial ablation procedures. The article first outlines how imaging modalities are routinely used in the peri-ablation period. We then describe how advanced imaging techniques may inform patient selection for ablation and ablation targets themselves. Ongoing research directions for improving catheter ablation outcomes by using imaging combined with advanced analyses for personalization of ablation targets are discussed, together with approaches for their integration in the standard clinical environment. Finally, we describe future research areas with the potential to improve catheter ablation outcomes.
Topics: Atrial Fibrillation; Atrial Flutter; Catheter Ablation; Heart Atria; Humans; Multimodal Imaging; Treatment Outcome
PubMed: 34747450
DOI: 10.1093/ehjci/jeab205 -
Physiological Research Nov 2022Functional and structural changes, the enlargement of the right atrium is the background for the development of typical atrial flutter (AFL). These changes in ECG are...
Functional and structural changes, the enlargement of the right atrium is the background for the development of typical atrial flutter (AFL). These changes in ECG are manifested in the morphology of the initial part of the P-wave. The aim of the study was to assess the duration and morphology of the P-wave in patients with paroxysmal and persistent AFL. The study population consisted of 131 patients with AFL, 38 women and 93 men aged 66 years (60-72), divided in 62 patients with paroxysmal and 69 with persistent AFL. P-wave duration was measured with an electrophysiological system in all leads at a paper speed of 200 mm/s. The groups did differ in terms of gender (38/24 vs. 55/14, (M/F), p=0.033). Patients with persistent AF had a longer P-wave duration - 175±26.3 ms vs. 159±22.6 ms, p=0.01, and higher creatinine concentration - 1.2±0.60 mg/dl vs. 1.08±0.68 mg/dl, p=0.007. The presence and severity of interatrial conduction block (I-none, II-partial, III-total) was related to age of the patients (60.3±12.1 vs. 64.7±-8.3 vs. 68.9±9.5 years, respectively). Patients with persistent AFL show a longer P-wave compared to paroxysmal AFL, regardless of comorbidities and antiarrhythmic drugs. The arrhythmia-related longer P-wave duration should encourage the clinicians to restore sinus rhythm earlier in order to more effectively maintain it over the long term.
Topics: Male; Humans; Female; Atrial Flutter; Atrial Fibrillation; Electrocardiography; Heart Atria; Anti-Arrhythmia Agents
PubMed: 36073736
DOI: 10.33549/physiolres.934731 -
Texas Heart Institute Journal Dec 2016
Topics: Action Potentials; Anti-Arrhythmia Agents; Atrial Flutter; Atrioventricular Node; Catheter Ablation; Electrocardiography; Flecainide; Heart Rate; Humans; Male; Middle Aged; Predictive Value of Tests; Tachycardia, Supraventricular; Treatment Outcome
PubMed: 28100969
DOI: 10.14503/THIJ-16-6088 -
Journal of Interventional Cardiac... Apr 2017Atrial fibrillation (AF) and cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) are two separate entities that coexist in a significant percentage of patients.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Atrial fibrillation (AF) and cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) are two separate entities that coexist in a significant percentage of patients. We sought to investigate whether AF inducibility during CTI AFL ablation predicted the occurrence of AF at follow-up after successful AFL ablation.
METHODS
A systemic review of Medline, Cochrane, and Embase was done for all the clinical studies in which assessment of AF inducibility in patients undergoing ablation for CTI AFL was performed. Given the low heterogeneity (i.e., I <25), we used a fixed effect model for our analysis.
RESULTS
A total of 10 studies (4 prospective and 6 retrospective) with a total of 1299 patients (male, 73%; mean age 59 ± 11 years) fulfilled the inclusion criteria. During a mean follow-up period of 23 ± 7.6 months, 407 patients (31%) developed AF during AFL ablation. The overall incidence for new-onset AF during follow-up was 29% (47% in the group with inducible AF vs. 21% in the non-inducible group). The odds ratio (OR) for developing AF after AFL ablation in patients with AF inducibility for all studies combined was 3.72, 95% CI 2.83-4.89 [prospective studies (OR 5.52, 95% CI 3.23-9.41) vs. retrospective studies (OR 3.23, 95% CI 2.35-4.45)].
CONCLUSIONS
Although ablation for CTI AFL is highly effective, AF continues to be a long-term risk for individuals undergoing this procedure. AF induced by pacing protocols in patients undergoing CTI AFL predicts for future AF. Inducible AF is a clinically relevant finding that may help guide decisions for long-term anticoagulation after successful typical AFL ablation especially in patients with elevated CHADS-VASc scores (≥2) and in considering prophylactic PVI during CTI AFL ablation.
Topics: Atrial Fibrillation; Atrial Flutter; Catheter Ablation; Causality; Comorbidity; Female; Humans; Male; Middle Aged; Postoperative Complications; Prognosis; Reproducibility of Results; Risk Factors; Sensitivity and Specificity
PubMed: 28070875
DOI: 10.1007/s10840-016-0211-9 -
ESC Heart Failure Dec 2022The aim of the study was to evaluate the prevalence of left atrial thrombus (LAT) on transoesophageal echocardiography (TOE) in patients with atrial fibrillation or... (Observational Study)
Observational Study
AIMS
The aim of the study was to evaluate the prevalence of left atrial thrombus (LAT) on transoesophageal echocardiography (TOE) in patients with atrial fibrillation or atrial flutter (AF/AFl) with reference to the presence of heart failure (HF) and its subtypes.
METHODS AND RESULTS
The research is a sub-study of the multicentre, prospective, observational Left Atrial Thrombus on Transoesophageal Echocardiography (LATTEE) registry, which comprised 3109 consecutive patients with AF/AFl undergoing TOE prior to direct current cardioversion or catheter ablation. TOE parameters, including presence of LAT, were compared between patients with and without HF and across different subtypes of HF, including HF with preserved (HFpEF), mid-range (HFmrEF), and reduced ejection fraction (HFrEF). HF was diagnosed in 1336 patients (43%). HF patients had higher prevalence of LAT than non-HF patients (12.8% vs. 4.4%; P < 0.001). LAT presence increased with more advanced type of systolic dysfunction (HFpEF vs. HFmrEF vs. HFrEF: 7.4% vs. 10.5% vs. 20.3%; P < 0.001). Univariate analysis revealed that HFrEF (odds ratio [OR] 4.13; 95% confidence interval [95% CI]: 3.13-5.46), but not HFmrEF or HFpEF, was associated with the presence of LAT. Multivariable logistic regression indicated that lower left ventricular ejection fraction (OR per 1%: 0.94; 95% CI 0.93-0.95) was an independent predictor of LAT formation. Receiver operator characteristic analysis showed LVEF ≤48% adequately predicted increased risk of LAT presence (area under the curve [AUC] 0.74; P < 0.0001).
CONCLUSION
The diagnosis of HFrEF, but neither HFmrEF nor HFpEF, confers a considerable risk of LAT presence despite widespread utilization of adequate anticoagulation.
Topics: Humans; Atrial Fibrillation; Atrial Flutter; Heart Failure; Prognosis; Prospective Studies; Stroke Volume; Thrombosis; Ventricular Function, Left
PubMed: 36039813
DOI: 10.1002/ehf2.14105 -
Journal of Investigative Medicine High... 2020Tick-borne illness has been increasingly on the rise, since the first human case was reported in the late 1980s. is one of the most common reported causes of tick-borne...
Tick-borne illness has been increasingly on the rise, since the first human case was reported in the late 1980s. is one of the most common reported causes of tick-borne illness, particularly in the southern states of the United States. The clinical picture presents as a paradigm to the clinician, often missing the diagnosis without an appropriate history being taken and sometimes mistreated for other conditions. With the number of cases on the rise, new manifestations and clinical presentations due to continue to be reported. Our case report is one such case in a 46-year-old male from Arkansas, with known exposure to multiple tick bites who presented with classical symptoms and laboratory values of tick-borne illness leading to atrial flutter. This unusual manifestation of atrial flutter due to tick-borne illness is rare and poorly understood. Further studies on tick-borne illness due to may be needed to understand the systemic causes of the bacteria. In addition, in our case report, we bring to attention the standard presentation (symptoms, signs, and laboratory values) of tick-borne illness due to along with the current standard for diagnosis and treatment.
Topics: Animals; Arkansas; Atrial Flutter; Ehrlichia chaffeensis; Ehrlichiosis; Electrocardiography; Humans; Male; Middle Aged; Tick Bites; Ticks
PubMed: 32787462
DOI: 10.1177/2324709620950128