[Typical atrial flutter: history, mechanisms and radiofrequency "ablation"]

yipical atrial flutter can now be permanently cured by a single session of radiofrequency ablation, a non pharmacological technique. The term "atrial flutter" is in fact somewhat confusing. A review of the history of this form of tachycardia shows that atrial flutter is indeed a multiple entity. While the reentrant nature of atrial flutter has long been known, most cardiologists refer to the typical ECG aspect and right atrial macro reentry circuit with counterclockwise rotation, as described by Puech. It is now possible to classify these flutters according to their electrocardiographic aspect and electrophysiological mechanisms. This article describes the diagnostic signs of typical flutter, and provides a detailed description of the most frequently used radical therapy, namely catheter ablation of the cavotricuspidian isthmus. This technique delivers radiofrequency pulses, under continuous local temperature monitoring, in order to permanently interrupt conduction in this structure. Outcome is assessed with the pacing technique and local electrocardiography. In experienced hands the immediate success rate is very high, late recurrence is rare, and complications are virtually absent.