The History of Atrial Flutter Electrophysiology, from Entrainment to Ablation: A 100-Year Experience in the Precision Electrocardiology

Giuseppe Bagliani; Roberto De Ponti; Fabio M Leonelli; Michela Casella; Gemma Gaggiotti; Giovanni Volpato; Paolo Compagnucci; Antonio Dello Russo

doi:10.1016/j.ccep.2022.05.001

The History of Atrial Flutter Electrophysiology, from Entrainment to Ablation: A 100-Year Experience in the Precision Electrocardiology

Card Electrophysiol Clin. 2022 Sep;14(3):357-373. doi: 10.1016/j.ccep.2022.05.001. Epub 2022 Aug 22.

Authors

Giuseppe Bagliani¹, Roberto De Ponti², Fabio M Leonelli³, Michela Casella⁴, Gemma Gaggiotti⁵, Giovanni Volpato⁶, Paolo Compagnucci⁷, Antonio Dello Russo⁷

Affiliations

¹ Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Via Conca 71, Ancona 60126, Italy. Electronic address: giuseppe.bagliani@tim.it.
² Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy.
³ Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA; University of South Florida, FL 4202 East Fowler Avenue, Tampa, FL 33620, USA.
⁴ Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Via Conca 71, Ancona 60126, Italy.
⁵ Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Via Conca 71, Ancona 60126, Italy.
⁶ Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy.
⁷ Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Via Conca 71, Ancona 60126, Italy.

PMID: 36153119
DOI: 10.1016/j.ccep.2022.05.001

Abstract

Atrial flutter (AFL) is a regular supraventricular reentrant tachycardia generating a continuous fluttering of the baseline electrocardiography (ECG) at a rate of 250 to 300 beats per minute. AFL is classified based on the involvement of the cavo-tricuspid isthmus in the circuit. The "isthmic" (or type 1) AFL develops entirely in the right atrium; this circuit is commonly activated in a counter-clockwise direction, generating the common sawtooth ECG morphology in the inferior leads (slow descendent-fast ascendent). AFL can be nonisthmus dependent (type 2), often presenting with faster atrial rate and most commonly a left atrial location.

Keywords: Atypical atrial flutter; Catheter ablation; Electroanatomic mapping; Precision electrocardiology; Typical atrial flutter.

Publication types

Review

MeSH terms

Atrial Flutter* / surgery
Cardiac Electrophysiology
Catheter Ablation*
Electrocardiography
Heart Atria
Humans