Acute Termination of Atrial Flutter: Are New Class Antiarrhythmic Drugs the Best Choice?
The expression “atrial flutter” (AFI) covers a series of arrhythmias which are related to different physiopathological mechanisms: typical AFI (common and uncommon, referring respectively to the anti-clockwise and clockwise routes through the anatomical substrate of right atrium, septum-lateral wall and isthmus inferior vena cava-tricuspid) and the atypical AFI, in which the circuit is located differently. In the population the prevalence of AFI is less than one in a thousand. Uncommon AFI is ten times less frequent than common AFI. The atypical form includes a heterogeneous series of arrhythmias whose electroge-netic mechanism is not exhaustively known and in which the absence of an excitable gap makes it very difficult to achieve entrainment or reset through the technique of pacing. Recently Cheng et al.  have shown that the site of the atypical flutter circuit is the lower part of the right atrium, while Jais et al.  have reported some cases of left AFI. As a consequence of this, we suggest that the arrhythmias generally referred to as typical and atypical flutter can be considered as electrophysiologically different entities. This element might influence the different actions of drugs on AFI “tout-court”.
KeywordsAtrial Fibrillation Sinus Rhythm Atrial Flutter Underlying Heart Disease Acute Termination
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