Atrial Flutter

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  • The term ‘flutter’ originally designated visual and tactile rapid, regular atrial contraction, in contrast with the irregular vermiform contraction in atrial fibrillation.

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    The term ‘flutter’ originally designated visual and tactile rapid, regular atrial contraction, in contrast with the irregular vermiform contraction in atrial fibrillation.

    Clinical electrophysiology has made the traditional classification of rapid atrial rhythms into flutter and tachycardia of little practical clinical use.

    In patients without a history of heart disease, cardiac surgery or catheter ablation, typical flutter ECG remains predictive of a right atrial re-entry circuit dependent on the inferior vena cava–tricuspid isthmus. This can be very effectively treated by ablation, although late incidence of atrial fibrillation remains a problem.

    Secondary prevention, based on the treatment of associated atrial fibrillation risk factors, is emerging as a therapeutic option. In patients undergoing cardiac surgery or catheter ablation for the treatment of atrial fibrillation or showing atypical ECG patterns, macro re-entrant and focal tachycardia mechanisms can be very complex and electrophysiological studies are necessary to guide ablation treatment in poorly tolerated cases.

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