Atrial flutter: arrhythmia circuit and basis for radiofrequency catheter ablation

The term atrial flutter was introduced 90 years ago for an arrhythmia with a unique electrocardiographic pattern. The development of endocardial mapping techniques in the last decade allowed the detailed characterization of the tachycardia circuit and the identification of the cavotricuspid isthmus as its critical part. This review stresses the position of atrial flutter in the new classification of atrial tachycardias and focuses on its unique electrophysiological characteristics and different variants described in humans. Transcatheter radiofrequency ablation across the cavotricuspid isthmus constitutes a feasible and safe therapy, which prevents flutter recurrences during the long-term follow-up. This paper describes the different techniques that validate bidirectional isthmus block, which is an important endpoint for successful ablation.