Atrial flutter: from ECG to electroanatomical 3D mapping

Abstract

Atrial flutter is a common arrhythmia that may cause significant symptoms, including palpitations, dyspnea, chest pain and even syncope. Frequently it’s possible to diagnose atrial flutter with a 12-lead surface ECG, looking for distinctive waves in leads II, III, aVF, aVL, V1,V2. Puech and Waldo developed the first classification of atrial flutter in the 1970s. These authors divided the arrhythmia into type I and type II. Therefore, in 2001 the European Society of Cardiology and the North American Society of Pacing and Electrophysiology developed a new classification of atrial flutter, based not only on the ECG, but also on the electrophysiological mechanism. New developments in endocardial mapping, including the electroanatomical 3D mapping system, have greatly expanded our understanding of the mechanism of arrhythmias. More recently, Scheinman et al, provided an updated classification and nomenclature. The terms like common, uncommon, typical, reverse typical or atypical flutter are abandoned because they may generate confusion. The authors worked out a new terminology, which differentiates atrial flutter only on the basis of electrophysiological mechanism.

Ablation of Left Atrial Tachycardia following Catheter Ablation of Atrial Fibrillation: 12-Month Success Rates

“…The complexity and variability of these circuits is related to the presence of zones of block, slow conduction, and electrically silent areas. 3D electro-anatomical mapping systems have improved the understanding of complex AT mechanisms while facilitating mapping as well as guiding ablation [19][20][21]. However, depending on the alterations of the underlying substrate, especially the presence of areas of a very low voltage, the interpretation of the AT may be misleading, even by the use of high-resolution mapping systems.…”

Non-Invasive Characterization of Atrial Flutter Mechanisms Using Recurrence Quantification Analysis on the ECG: A Computational Study

“…However, the characterization of the dynamical structures underlying electrophysiological (EP) phenomena from the perspective of non-linear and non-invasive time series analysis is still lacking. In fact, AFl mechanisms are usually discriminated from invasive intracardiac signals [3], [15], whereas noninvasive methods -using traditional 12-leads ECGs, for instance -are mostly used for the clinical detection of AFl with respect to AFib [16]. The non-invasive discrimination of AFl mechanisms would help to delineate the ablation strategy, reducing time and resources required to conduct invasive cardiac mapping and ablation procedures.…”