Typical Atrial Flutter: Antiarrhythmic Drugs or Ablation as First-Line Therapy?

  • N. F. Marrouche
  • A. Natale
Conference paper


Since Lewis postulated in 1920 that atrial flutter is due to reentrant circuit, a large body of evidence has advanced our understanding of the electrophysiologic substrate of typical atrial flutter and has enhanced our ability to treat this arrhythmia. Rosenblueth and Garcia-Ramos [1] and Frame et al. [2, 3] first described in an animal model the critical role of the anatomical boundaries in maintaining the flutter circuit. By creating a lesion between the orifices of the venae cavae and extending the lesion to the appendage, a model of atrial flutter was developed. Interestingly, the tricuspid annulus served as the anterior barrier and the crush lesion or incision served as the posterior barrier of the macroreentrant flutter circuit. These models introduced the concept that atrial flutter is a macroreentrant circuit maintained by anatomical barriers including: (1) the tricuspid annulus; (2) the cavity of the right atrium; and (3) the induced surgical barrier that prevents short-circuiting of the macroreentrant circuit within the right atrial free wall. Boineau et al. demonstrated in a canine model that the crista terminalis could replace the crush incision as the posterior barrier of the flutter circuit [4].


Atrial Fibrillation Coronary Sinus Catheter Ablation Atrial Flutter Tricuspid Annulus 
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Copyright information

© Springer-Verlag Italia 2002

Authors and Affiliations

  • N. F. Marrouche
    • 1
  • A. Natale
    • 1
  1. 1.Division of Pacing and Electrophysiology, Department of CardiologyThe Cleveland Clinic FoundationClevelandUSA

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