This Article Free upon publication Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wellens, H. J.J. Search for Related Content PubMed PubMed Citation Articles by Wellens, H. J.J. Related Collections Electrophysiology Cardiovascular Pharmacology Ablation/ICD/surgery Echocardiography Arrhythmias, clinical electrophysiology, drugs

(Circulation. 2002;106:649.)
© 2002 American Heart Association, Inc.

Clinician Update

Contemporary Management of Atrial Flutter

Hein J.J. Wellens, MD

From the Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands.

Correspondence to Hein J.J. Wellens, MD, 21 Henric van Veldekeplein, 6211 TG Maastricht, The Netherlands. E-mail hwellens@xs4all.nl

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
A 60-year-old dentist presents to the emergency room with palpitations for 3 hours. The ECG shows atrial flutter (AFl) with atrioventricular (AV) conduction varying from 2:1 to 4:1. He has known hypertension for which he takes 10 mg of enalapril daily. In the last 2 years he was seen twice because of AFl and on both occasions 1 mg of ibutilide IV resulted in the return of sinus rhythm with 1:1 AV conduction. Catheter ablation of the arrhythmia is discussed with the patient, to which he agrees and curative AFl ablation is scheduled in 4 weeks.

History
In 1906, Einthoven made an electrocardiographic recording of AFl.¹ In 1913, Lewis called attention to the typical saw tooth pattern and the negative deflections of the atrial waves in leads II and III.²

During the next 50 years, there was much discussion about whether AFl was caused by a rapidly firing atrial focus or is the result of a large circus movement involving the atria. After mapping atrial activation with endocardial and esophageal recordings, Puech et al³ concluded that the flutter cycle in the human heart involved activation of the whole right atrium. Stimulation studies by Waldo et al⁴ revealed that in postoperative AFl the arrhythmia was based on a reentry mechanism involving a large atrial area. They demonstrated the presence of an excitable gap that allowed the speeding up of the flutter rate during atrial pacing and termination of the arrhythmia by pacing.

Mechanism and Types of Macroreentrant Tachycardias
With the use of endocardial activation mapping and stimulation studies, . . . [Full Text of this Article]

This article has been cited by other articles:

				W. Moreira, C. Timmermans, H. J.J. Wellens, Y. Mizusawa, S. Philippens, D. Perez, and L.-M. Rodriguez Can Common-Type Atrial Flutter Be a Sign of an Arrhythmogenic Substrate in Paroxysmal Atrial Fibrillation?: Clinical and Ablative Consequences in Patients With Coexistent Paroxysmal Atrial Fibrillation/Atrial Flutter Circulation, December 11, 2007; 116(24): 2786 - 2792. [Abstract] [Full Text] [PDF]

				A. Da Costa, J. Thevenin, F. Roche, C. Romeyer-Bouchard, L. Abdellaoui, M. Messier, L. Denis, E. Faure, R. Gonthier, G. Kruszynski, et al. Results From the Loire-Ardeche-Drome-Isere-Puy-de-Dome (LADIP) Trial on Atrial Flutter, a Multicentric Prospective Randomized Study Comparing Amiodarone and Radiofrequency Ablation After the First Episode of Symptomatic Atrial Flutter Circulation, October 17, 2006; 114(16): 1676 - 1681. [Abstract] [Full Text] [PDF]

				R. Manusama, C. Timmermans, F. Limon, S. Philippens, H. J.G.M. Crijns, and L.-M. Rodriguez Catheter-Based Cryoablation Permanently Cures Patients With Common Atrial Flutter Circulation, April 6, 2004; 109(13): 1636 - 1639. [Abstract] [Full Text] [PDF]