Typical Atrial Flutter

  • Kevin Ming Wei LeongEmail author


Typical atrial flutter is one of the most common of the atrial tachyarrhythmias and highly amenable to catheter ablation. This is based on a clear understanding of its electroanatomical circuit and critical dependence upon the cavo-tricuspid isthmus. Achieving a line of block across this isthmus is associated with a low rate of recurrence, reduced morbidity and improved quality of life.


Atrial flutter Atrial tachycardia Cavo-tricuspid isthmus Catheter ablation Electrophysiological techniques 


  1. 1.
    Granada J, Uribe W, Chyou P-H, et al. Incidence and predictors of atrial flutter in the general population. J Am Coll Cardiol. 2000;36(7):2242–6. Scholar
  2. 2.
    Tai CT, Chen SA. Cavotricuspid isthmus: anatomy, electrophysiology, and long-term outcome of radiofrequency ablation. Pacing Clin Electrophysiol. 2009. Scholar
  3. 3.
    Bun SS, Latcu DG, Marchlinski F, Saoudi N. Atrial flutter: more than just one of a kind. Eur Heart J. 2015. Scholar
  4. 4.
    Okumura K, Plumb VJ, Pagé PL, Waldo AL. Atrial activation sequence during atrial flutter in the canine pericarditis model and its effects on the polarity of the flutter wave in the electrocardiogram. J Am Coll Cardiol. 1991. Scholar
  5. 5.
    Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: executive summary. J Am Coll Cardiol. 2016;67(13):1575–623. Scholar
  6. 6.
    Stambler BS, Wood MA, Ellenbogen KA et al, Stambler BS, Wood MA, et al. Efficacy and safety of repeated intravenous doses of ibutilide for rapid conversion of atrial flutter or fibrillation. Ibutilide repeat dose study investigators. Circulation. 1996;94(7):1613–21. Scholar
  7. 7.
    Singh S, Zoble RG, Yellen L, et al. Efficacy and safety of oral dofetilide in converting to and maintaining sinus rhythm in patients with chronic atrial fibrillation or atrial flutter: the symptomatic atrial fibrillation investigative research on dofetilide (SAFIRE-D) study. Circulation. 2000;102(19 Suppl.):2385–90. Scholar
  8. 8.
    Ghali WA, Wasil BI, Brant R, Exner DV, Cornuz J. Atrial flutter and the risk of thromboembolism: a systematic review and meta-analysis. Am J Med. 2005;118(2):101–7. Scholar
  9. 9.
    Vadmann H, Nielsen PB, Hjortshøj SP, et al. Atrial flutter and thromboembolic risk: a systematic review. Heart. 2015;101(18):1446–55. Scholar
  10. 10.
    Watson RM, Josephson ME. Atrial flutter. I. Electrophysiologic substrates and modes of initiation and termination. Am J Cardiol 1980;45(4):732–41. Scholar
  11. 11.
    Olgin JE, Kalman JM, Saxon LA, Randall JL, Lesh MD. Mechanism of initiation of atrial flutter in humans: site of unidirectional block and direction of rotation. J Am Coll Cardiol. 1997;29(2):376–84. Scholar
  12. 12.
    Disertori M, Inama G, Vergara G, Guarnerio M, Del Favero A, Furlanello F. Evidence of a reentry circuit in the common type of atrial flutter in man. Circulation. 1983;67(2):434–40. Scholar
  13. 13.
    Josephson ME. Clinical cardiac electrophysiology: techniques and interpretations, 5th ed. Wolters Kluwer;2016.Google Scholar
  14. 14.
    Waldo AL, MacLean WAH, Karp RB, Kouchoukos NT, James TN. Entrainment and interruption of atrial flutter with atrial pacing. Studies in man following open heart surgery. Circulation. 1977;56(5):737–45. Scholar
  15. 15.
    Pérez FJ, Schubert CM, Parvez B, Pathak V, Ellenbogen KA, Wood MA. Long-term outcomes after catheter ablation of cavo-tricuspid isthmus dependent atrial flutter: a meta-analysis. Circ Arrhythmia Electrophysiol. 2009;2(4):393–401. Scholar
  16. 16.
    Patel NJ, Deshmukh A, Pau D, et al. Contemporary utilization and safety outcomes of catheter ablation of atrial flutter in the United States: analysis of 89,638 procedures. Hear Rhythm. 2016;13(6):1317–25. Scholar
  17. 17.
    Issa ZF, Miller JM, Zipes DP. Clinical arrhythmology and electrophysiology: a companion to braunwald’s heart disease, 2nd ed. Elsevier Inc.;2012.
  18. 18.
    Zambito PE, Palma EC. DP+1: another simple endpoint for atrial flutter ablation. J Cardiovasc Electrophysiol. 2008;19(1):10–3. Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Imperial College Healthcare NHS TrustLondonUK
  2. 2.National Heart & Lung Institute, Imperial College LondonLondonUK

Personalised recommendations