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Atypical atrial flutters.

P Ricard¹, M Imianitoff, K Yaïci

¹Centre Hospitalier Princess Grace, Monaco.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology

|July 24, 2002

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Typical atrial flutter, characterized by a specific ECG pattern, is increasingly classified by its dependence on the cavo-tricuspid isthmus. This reclassification includes arrhythmias previously considered atypical, broadening the understanding of atrial flutter.

Area of Science:

Cardiology
Electrophysiology
Cardiac Arrhythmias

Background:

Typical atrial flutter is traditionally defined by a counterclockwise macro-re-entry circuit in the right atrium and a characteristic ECG pattern.
The surface ECG typically shows negative F waves in inferior leads and positive F waves in V1 for typical atrial flutter.

Purpose of the Study:

To explore the proposed reclassification of atrial flutter based on cavo-tricuspid isthmus dependence rather than solely on ECG patterns.
To identify atrial flutter subtypes that may be considered typical despite atypical ECG findings.

Main Methods:

Review of current literature and proposed classification systems for atrial flutter.
Analysis of electrophysiological criteria for defining typical versus atypical atrial flutter.

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Main Results:

Some atrial flutters, including reverse typical atrial flutter, lower loop re-entry, and partial-isthmus-dependent short circuit flutter, may be classified as typical based on isthmus dependence, even with non-typical ECG patterns.
Atypical flutter is generally defined as non-isthmus dependent, often occurring in patients with prior cardiac surgery or right atrial scars.

Conclusions:

Classification of atrial flutter should consider cavo-tricuspid isthmus dependence as a primary criterion.
This revised classification approach accommodates flutter mechanisms that may not present with classic ECG findings, enhancing diagnostic accuracy.