[Differential modifiability of a usual and unusual type of atrial flutter by high frequency atrial stimulation]

By means of highly frequent transoesophageal (left-atrial) atrial stimulation 69 patients with atrial flutter of type I (negative flutter waves in the leads II, III and aVF) and 35 patients with atrial flutter type II (positive flutter waves in the corresponding leads from the extremities) were treated and the results were compared with the results of right-atrial highly frequent stimulation (15 patients with type I atrial flutter, 6 patients with type II atrial flutter). In these cases the atrial flutter of type I nearly without any exception could be influenced by transoesophageal as well as by right-atrial stimulation (transfer into sinus rhythm, atrial fibrillation or atrial flutter of type II). The rate of success of the right-atrial as well as of the transoesophageal (left-atrial) stimulation was clearly lower in the atrial flutter of type II than in the atrial flutter of type I, in which cases are to be discussed as causes the slightly higher frequency of atrial flutter in type II, a smaller reentry circle, a higher rate of mechanisms of focal tachycardia and - in one part of the patients - an origin of tachycardia in the left atrium.