The electrocardiogram shows a saw tooth's pattern in inferior leads, with a slow downward slope followed by a fast upward slope explained by electrical forces going through the cavotricuspid isthmus and the septum, and then approaching the inferior leads through the lateral wall (Figure 1).(4,5) This saw tooth’s appearance could be easily registered when the ventricular rate response is controlled. The wave front may rotate around this circuit counterclockwise (most frequently) or clockwise, resulting in the counterclockwise common atrial flutter or the clockwise atrial flutter, respectively.(4,5) This condition produces continuous electrical activity around the atrial circuit and consequently in the electrocardiogram (f waves).
Typical atrial flutter originates in a well-known circuit around the tricuspid annulus limited by anatomical barriers such as both the superior and inferior cava veins, the coronary sinus and crista terminalis. (4) Ventricular rate response will be limited by the atrioventricular (AV) node conductions, usually presenting a 2:1 or 3:1 response, during atrial flutter. This arrhythmia has a 200-260 ms cycle length, although it may fluctuate depending on patient's previous treatment or ablation, congenital heart disease, etc. It can also be defined as a macroreentrant tachycardia confined to the right atrium. Typical atrial flutter is an organised atrial tachycardia. We present a brief report describing common atrial flutter as well as the main atypical forms, with a focus on description of their circuits, and main electrocardiographic patterns. Loss of atrioventricular synchronisation and physiological rate response to activity can also decrease functional class in patients with ventricular dysfunction. In patients with chronic obstructive pulmonary disease with concomitant bronchodilators especially, controlling the ventricular rate could be challenging with an increased risk of 1:1 ventricular response. Typical atrial flutter cases (AFL-I) make up 22% of all 8,546 ablation procedures in the Spanish National Ablation's Registry (behind atrioventricular nodal reentrant tachycardia, accessory pathways but ahead of atrial fibrillation).įurthermore, atrial flutter is considered to hold as much risk as atrial fibrillation for thromboembolic events (3-4% per year).(2,3) Atrial flutter also carries a proarrhythmic risk, and additionally, rhythm control and ventricular rate response can only hardly be achieved with medical treatment.
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