Paroxysmal Atrial Flutter: Which Mechanism and Treatment in the Era of Catheter Ablation?
Atrial flutter (AF), a common rhythm disturbance, was first described several decades ago (1). Despite extensive investigation, several important issues remain unresolved concerning its mechanism and its management. Indeed, for greater clarity, it should be recalled that this term mainly covers the common form (still called type I flutter), defined as an atrial tachycardia with a constant rate, polarity, and morphology of locally recorded electrograms. A “saw tooth” pattern (inverted P waves) is present in the inferior leads on the electrocardiogram. The morphological criterion is actually prevalent, the diagnosis of flutter being compatible with atrial frequencies higher than 300/min, or lower between 200 and 250/min Type II AF is characterized by a similar uniformity of the atrial electrogram appearance, but the rate is faster. While both are likely due to a reentrant mechanism, type I AF can often be stopped by rapid atrial pacing or can be transformed to type II AF (2–5).
KeywordsInferior Vena Cava Catheter Ablation Atrial Flutter Right Atrium Radiofrequency Catheter Ablation
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