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Electrocardiographic Approach to Atrial Flutter: Classifications and Differential Diagnosis
Giuseppe Bagliani1, Fabio M Leonelli2, Roberto De Ponti3
1Cardiology And Arrhythmology Clinic, University Hospital "Ospedali Riuniti", via Conca 71, 60100 Ancona, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy.
Abstract:
Atrial flutter (AFL) is a macro-reentrant arrhythmia characterized, in a 12 lead ECG, by the continuous oscillation of the isoelectric line in at least one lead. In the typical form of AFL, the oscillation is most obvious in the inferior leads, due to a macro-reentrant circuit localized in the right atrium, with the cavo-tricuspid isthmus as a critical zone.: This circuit can be activated in a counterclockwise or clockwise direction generating in II, III, and aVF leads, respectively, a slow descending/fast ascending F wave pattern (common form of typical AFL) or a balanced ascending/descending waveform (uncommon form of typical AFL). Atypical AFLs (scar-related) do not include the CTI in the circuit and show an extremely variable circuit location and ECG morphology.
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