Atypical Atrial Flutter: Review of Mechanisms, Advances in Mapping and Ablation Outcomes

Document Type

Article

Publication Date

1-1-2022

Publication Title

Current Opinion in Cardiology

Volume

37

Issue

1

First page number:

36

Last page number:

45

Abstract

PURPOSE OF REVIEW: Atrial flutter (AFL) is the second most prevalent arrhythmia after atrial fibrillation (AF). It is a macro-reentrant tachycardia that is either cavotricuspid isthmus dependent (typical) or independent (atypical). This review aims at highlighting mechanism, diagnosis and treatment of atypical AFL and the recent developments in electroanatomic mapping. RECENT FINDINGS: Incidence of left AFL is at an exponential rise presently with increase in AF ablation rates. The mechanism of left AFL is most often peri-mitral, roof-dependent or within pulmonary veins in preablated, in contrast to posterior or anterior wall low voltage areas in ablation naïve patients. Linear lesions, compared to pulmonary vein isolation alone, have higher incidence of atypical right or left AFL. Catheter ablation for atypical AFL is associated with lower rates of thromboembolic events, transfusions, and length of stay compared to typical AFL. SUMMARY: Advances in mapping have allowed rapid simultaneous acquisition of automatically annotated points in the atria and identification of details of macro-reentrant circuits, including zones of conduction block, scar, and slow conduction.

Controlled Subject

Atrial flutter; Arrhythmia; Tachycardia

Disciplines

Cardiology | Cardiovascular System

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