![]() Lower loop reentry atrial flutter uses a circuit that includes the CTI, as common atrial flutter, but it shortens the circuit through a gap in the crista terminalis. The definition of atypical atrial flutter includes a broad spectrum of other macroreentrant tachycardias in which the wave front does not travel around the tricuspid annulus.Ītypical right atrial flutter other than reverse typical atrial flutter, includes the following: lower loop reentry, fosa ovalis flutter, superior vena cava flutter and upper loop reentry (Figure 2). Acute success rate is almost 95% in the registries.(1) However, at 5 year follow-up almost 70% of these patients might develop atrial fibrillation or atypical atrial flutter, which is probably related to the baseline characteristics, structural heart disease and uncontrolled risk factors. See here, previous article on flutter’s differential diagnoses and treatment approaches). (For a closer look at ablation, see previous e-journal articles on rhythmologist's view on the patient after the procedure, or surgeons' look at procedure in lone atrial fibrillation. The ablation procedure's main target is to achieve bidirectional block through the cavotricuspid isthmus (CTI). After the first episode of AFL-I (Class IIa indication), especially in those presenting with poor hemodynamic tolerance or tachymiocardiopathy.In AFL-I recurrences despite medical treatment (Class I indication).(6,7)Įlectrophysiological studies (EPs) are indicated: In the second case, a regular irregularity has to be always ruled out. In the first case, vagal maneuvers or AV node blocking drugs, such as adenosine, may be useful. Both high and irregular ventricular rate responses may make the diagnosis difficult. ![]()
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