Atrial Flutter: Diagnosis and Management strategies

Abstract

Atrial flutter (AFL) is a regular, macro reentrant arrhythmia traditionally defined as a supraventricular tachycardia with an atrial rate of 240-320 beats per minute (bpm). Pathophysiology of atrial flutter and atrial fibrillation (AF) is closely related to the similar risk of stroke and they coexist clinically. Atrial flutter is classified to cavotricuspid isthmus (CTI) dependent (or typical) and non-isthmus dependent (atypical). Isthmus is a distinct structure in the right atrium (RA) through which atrial flutter passes and makes a good target for ablation therapy. Ablation is the primary therapy in atrial flutter, particularly in CTI dependent group, with regard to its safety profile and high success rate of approximately 90%. Three-dimensional electroanatomic mapping is progressively being used to ablate atypical forms of atrial flutter.

Impact of cavotricuspid isthmus ablation for typical atrial flutter and heart failure in the elderly—results of a retrospective multi-center study

“…Activation goes downward in the right atrium free wall, through the CTI, and ascends in the right septum (2,3). AFL comes with many potentially severe complications, including atrial fibrillation (AF), AFL induced tachycardiomyopathy, heart failure (HF) and thromboembolic events leading to stroke (4)(5)(6)(7)(8). The pathophysiological mechanism of AFL consists of greatly increased atrial frequencies that lead to a consecutive overload of the atria, to a reduced filling of the atria and ultimately to a reduced ejection of blood volume from both the atria and the ventricles.…”