Inter-Relationships of Atrial Fibrillation and Atrial Flutter

Abstract

There is a close interrelationship between atrial fibrillation (AF) and atrial flutter (AFL). Atrial fibrillation of variable duration precedes the onset of AFL in almost all instances; during AF, the functional components needed to complete the AFL re-entrant circuit, principally a line of block (LoB) between the vena cavae, are formed; if this LoB does not form, classical AFL does not develop. In contrast, there seems to be a spectrum of atrial re-entrant circuits (drivers) of short cycle lengths (CLs) (i.e., AFL). When the CL of the AFL re-entrant circuit is so short that it will only activate portions of the atria in a 1:1 manner, the rest of the atria will be activated rapidly but irregularly (i.e., via fibrillatory conduction), resulting in AF. In short, there are probably several mechanisms of AF, 1 of which is due to a very rapid AFL causing fibrillatory conduction. All of these interactions of AF and AFL have important clinical implications.

Inflammation-sensitive proteins and risk of atrial fibrillation: a population-based cohort study

“…AF was defined as a diagnosis of either atrial fibrillation or atrial flutter as in previous studies (6)(7)(8)24), given the close relationship between these diseases (25). Subjects were considered to have AF if diagnosed with a primary or contributory hospital discharge diagnosis code 427.92 (ICD-8), 427D (ICD-9) or I48 (ICD-10).…”

Theoretical considerations for mapping activation in human cardiac fibrillation

“…11,16 Ideally, human AF would be mapped in situ during clinical electrophysiologic study to avoid open heart surgery while enabling direct therapy (ablation) based upon patientspecific mapping results. 1 It is often suggested that human AF mapping requires high spatiotemporal resolution with narrow field of view, 7,17 as in prior open-heart studies, rather than wide-field of view with moderate spatial resolution that is readily achievable by percutaneous methods. If true, this would essentially preclude mapping of human AF at clinical electrophysiologic study with its attendant benefits and opportunities for patient-tailored mechanistic therapy.…”

GIANT Flutter Waves in ECG Lead V1: a Marker of Pulmonary Hypertension

“…There was no underlying left heart disease in the three patients with primary pulmonary hypertension or idiopathic pulmonary fibrosis. Representative ECGs from three of the patients are shown [figures [1][2][3]. In addition to the presence of "giant" flutter waves on their electrocardiogram, and an underlying pathology that included the presence of or history of pulmonary hypertension, each of the patients on echocardiography had findings of right ventricular dilation and/or mechanical dysfunction and visually assessed right atrial enlargement.…”

“…[2][3][4] Most often, atrial flutter takes the form of a right atrial reentrant arrhythmia revolving around the RA isthmus in a clockwise or counterclockwise direction, in which it is referred to a "typical" AFl and produces a "sawtooth" pattern to the flutter waves -especially in the inferior ECG leads; other forms morphologically and/or in location have been considered as "atypical" flutter . [5][6] Among the many structural heart disease alterations to which AFl has been linked is pulmonary hypertension, 7 whether from congenital 8 or acquired disorders.However, no specifics of the morphological characteristics of the flutter in the setting of pulmonary hypertension have been described.…”