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Typical atrial flutter

MedGen UID:
923694
•Concept ID:
C3264370
•
Pathologic Function
Synonyms: Atrial flutter type 1; Atrial flutter type I
SNOMED CT: Typical atrial flutter (720448006); Atrial flutter type I (720448006); Atrial flutter type 1 (720448006)
 
HPO: HP:0031671

Definition

Typical atrial flutter is an organised atrial tachycardia. It can also be defined as a macroreentrant tachycardia confined to the right atrium. This arrhythmia has a 200-260 ms cycle length, although it may fluctuate depending on patient's previous treatment or ablation, congenital heart disease, etc. Ventricular rate response will be limited by the atrioventricular node conductions, usually presenting a 2:1 or 3:1 response, during atrial flutter. Typical (counter clockwise) flutter is associated with the common flutter pattern [from HPO]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVTypical atrial flutter

Professional guidelines

PubMed

Electrocardiographic Approach to Atrial Flutter: Classifications and Differential Diagnosis.
Bagliani G, Leonelli FM, De Ponti R, Casella M, Massara F, Tofoni P, Guerra F, Ciliberti G, Russo AD
Card Electrophysiol Clin 2022 Sep;14(3):385-399. Epub 2022 Aug 25 doi: 10.1016/j.ccep.2022.05.007. PMID: 36153121
Diagnosis and management of typical atrial flutter.
Sawhney NS, Anousheh R, Chen WC, Feld GK
Cardiol Clin 2009 Feb;27(1):55-67, viii. doi: 10.1016/j.ccl.2008.09.010. PMID: 19111764
Management of atrial flutter.
Kongsgaard E, Aass H
Curr Cardiol Rep 2000 Jul;2(4):314-21. doi: 10.1007/s11886-000-0087-1. PMID: 10953265

Recent clinical studies

Etiology

Differences between typical and reverse typical atrial flutter identified by ultrahigh resolution mapping.
Hara S, Sato Y, Kusa S, Miwa N, Hirano H, Nakata T, Doi J, Hachiya H
J Cardiovasc Electrophysiol 2023 Aug;34(8):1658-1664. Epub 2023 Jul 2 doi: 10.1111/jce.15993. PMID: 37393583
Anticoagulation after typical atrial flutter ablation: Systematic review and meta-analysis.
Nunes-Ferreira A, Alves M, Lima da Silva G, Cortez-Dias N, de Sousa J, Pinto FJ, Caldeira D
Pacing Clin Electrophysiol 2021 Oct;44(10):1701-1710. Epub 2021 Sep 1 doi: 10.1111/pace.14342. PMID: 34409630
Typical atrial flutter but not fibrillation predicts coronary artery disease in formerly healthy patients.
Iden L, Richardt G, Weinert R, Groschke S, Toelg R, Borlich M
Europace 2021 Aug 6;23(8):1227-1236. doi: 10.1093/europace/euab002. PMID: 33611584
Atrial flutter update.
Cosío FG
Card Electrophysiol Rev 2002 Dec;6(4):356-64. doi: 10.1023/a:1021119905261. PMID: 12438813
Nonpharmacologic approaches to the treatment of atrial fibrillation and atrial flutter.
Baker BM, Smith JM, Cain ME
J Cardiovasc Electrophysiol 1995 Oct;6(10 Pt 2):972-8. doi: 10.1111/j.1540-8167.1995.tb00373.x. PMID: 8548118

Diagnosis

Typical Atrial Flutter Mapping and Ablation.
Notaristefano F, Zingarini G, Cavallini C, Bagliani G, De Ponti R, Leonelli FM
Card Electrophysiol Clin 2022 Sep;14(3):459-469. Epub 2022 Aug 25 doi: 10.1016/j.ccep.2022.06.007. PMID: 36153126
Interpretation of Typical and Atypical Atrial Flutters by Precision Electrocardiology Based on Intracardiac Recording.
Leonelli FM, Ponti R, Bagliani G
Card Electrophysiol Clin 2022 Sep;14(3):435-458. Epub 2022 Aug 25 doi: 10.1016/j.ccep.2022.05.004. PMID: 36153125
Electrocardiographic Approach to Atrial Flutter: Classifications and Differential Diagnosis.
Bagliani G, Leonelli FM, De Ponti R, Casella M, Massara F, Tofoni P, Guerra F, Ciliberti G, Russo AD
Card Electrophysiol Clin 2022 Sep;14(3):385-399. Epub 2022 Aug 25 doi: 10.1016/j.ccep.2022.05.007. PMID: 36153121
Diagnosis and management of typical atrial flutter.
Sawhney NS, Anousheh R, Chen WC, Feld GK
Cardiol Clin 2009 Feb;27(1):55-67, viii. doi: 10.1016/j.ccl.2008.09.010. PMID: 19111764
Atrial flutter update.
Cosío FG
Card Electrophysiol Rev 2002 Dec;6(4):356-64. doi: 10.1023/a:1021119905261. PMID: 12438813

Therapy

Anticoagulation after typical atrial flutter ablation: Systematic review and meta-analysis.
Nunes-Ferreira A, Alves M, Lima da Silva G, Cortez-Dias N, de Sousa J, Pinto FJ, Caldeira D
Pacing Clin Electrophysiol 2021 Oct;44(10):1701-1710. Epub 2021 Sep 1 doi: 10.1111/pace.14342. PMID: 34409630
Mapping and ablation of post-AF atrial tachycardias.
Chugh A
J Cardiovasc Electrophysiol 2021 Oct;32(10):2830-2844. Epub 2021 Jun 10 doi: 10.1111/jce.15047. PMID: 33928695
Diagnosis and management of typical atrial flutter.
Sawhney NS, Anousheh R, Chen WC, Feld GK
Cardiol Clin 2009 Feb;27(1):55-67, viii. doi: 10.1016/j.ccl.2008.09.010. PMID: 19111764
Diagnosis and management of typical atrial flutter.
Sawhney NS, Feld GK
Med Clin North Am 2008 Jan;92(1):65-85, x. doi: 10.1016/j.mcna.2007.08.005. PMID: 18060998
Atrial flutter update.
Cosío FG
Card Electrophysiol Rev 2002 Dec;6(4):356-64. doi: 10.1023/a:1021119905261. PMID: 12438813

Prognosis

Typical atrial flutter but not fibrillation predicts coronary artery disease in formerly healthy patients.
Iden L, Richardt G, Weinert R, Groschke S, Toelg R, Borlich M
Europace 2021 Aug 6;23(8):1227-1236. doi: 10.1093/europace/euab002. PMID: 33611584
Elevated Incidence of Atrial Fibrillation and Stroke in Patients With Atrial Flutter-A Population-Based Study.
Gula LJ, Redfearn DP, Jenkyn KB, Allen B, Skanes AC, Leong-Sit P, Shariff SZ
Can J Cardiol 2018 Jun;34(6):774-783. Epub 2018 Jan 6 doi: 10.1016/j.cjca.2018.01.001. PMID: 29801742
Myocardial injury during radiofrequency and cryoablation of typical atrial flutter.
Saygi S, Drca N, Insulander P, Schwieler J, Jensen-Urstad M, Bastani H
J Interv Card Electrophysiol 2016 Aug;46(2):177-81. Epub 2015 Nov 6 doi: 10.1007/s10840-015-0074-5. PMID: 26546105
Atrial fibrillation after typical atrial flutter ablation: a long-term follow-up.
Bandini A, Golia P, Caroli E, Biancoli S, Galvani M
J Cardiovasc Med (Hagerstown) 2011 Feb;12(2):110-5. doi: 10.2459/JCM.0b013e3283403301. PMID: 21045718
Atrial flutter update.
Cosío FG
Card Electrophysiol Rev 2002 Dec;6(4):356-64. doi: 10.1023/a:1021119905261. PMID: 12438813

Clinical prediction guides

Differences between typical and reverse typical atrial flutter identified by ultrahigh resolution mapping.
Hara S, Sato Y, Kusa S, Miwa N, Hirano H, Nakata T, Doi J, Hachiya H
J Cardiovasc Electrophysiol 2023 Aug;34(8):1658-1664. Epub 2023 Jul 2 doi: 10.1111/jce.15993. PMID: 37393583
Anticoagulation after typical atrial flutter ablation: Systematic review and meta-analysis.
Nunes-Ferreira A, Alves M, Lima da Silva G, Cortez-Dias N, de Sousa J, Pinto FJ, Caldeira D
Pacing Clin Electrophysiol 2021 Oct;44(10):1701-1710. Epub 2021 Sep 1 doi: 10.1111/pace.14342. PMID: 34409630
Typical atrial flutter but not fibrillation predicts coronary artery disease in formerly healthy patients.
Iden L, Richardt G, Weinert R, Groschke S, Toelg R, Borlich M
Europace 2021 Aug 6;23(8):1227-1236. doi: 10.1093/europace/euab002. PMID: 33611584
Atrial fibrillation after typical atrial flutter ablation: a long-term follow-up.
Bandini A, Golia P, Caroli E, Biancoli S, Galvani M
J Cardiovasc Med (Hagerstown) 2011 Feb;12(2):110-5. doi: 10.2459/JCM.0b013e3283403301. PMID: 21045718
Curative catheter ablation in atrial fibrillation and typical atrial flutter: systematic review and economic evaluation.
Rodgers M, McKenna C, Palmer S, Chambers D, Van Hout S, Golder S, Pepper C, Todd D, Woolacott N
Health Technol Assess 2008 Nov;12(34):iii-iv, xi-xiii, 1-198. doi: 10.3310/hta12340. PMID: 19036232

Recent systematic reviews

Anticoagulation after typical atrial flutter ablation: Systematic review and meta-analysis.
Nunes-Ferreira A, Alves M, Lima da Silva G, Cortez-Dias N, de Sousa J, Pinto FJ, Caldeira D
Pacing Clin Electrophysiol 2021 Oct;44(10):1701-1710. Epub 2021 Sep 1 doi: 10.1111/pace.14342. PMID: 34409630
Prophylactic pulmonary vein isolation in typical atrial flutter patients without atrial fibrillation: a systematic review and meta-analysis of randomized trials.
Fu B, Ran B, Zhang H, Luo Y, Wang J
J Interv Card Electrophysiol 2021 Apr;60(3):529-533. Epub 2020 May 18 doi: 10.1007/s10840-020-00772-4. PMID: 32424664
Cavotricuspid isthmus line in patients undergoing catheter ablation of atrial fibrillation with or without history of typical atrial flutter: A meta-analysis.
Romero J, Patel K, Briceno D, Lakkireddy D, Gabr M, Diaz JC, Alviz I, Polanco D, Della Rocca DG, Mohanty P, Mohanty S, Trivedi C, Natale A, Di Biase L
J Cardiovasc Electrophysiol 2020 Aug;31(8):1987-1995. Epub 2020 Jul 7 doi: 10.1111/jce.14614. PMID: 32530541
Meta-analysis of ablation of atrial flutter and supraventricular tachycardia.
Spector P, Reynolds MR, Calkins H, Sondhi M, Xu Y, Martin A, Williams CJ, Sledge I
Am J Cardiol 2009 Sep 1;104(5):671-7. doi: 10.1016/j.amjcard.2009.04.040. PMID: 19699343
Curative catheter ablation in atrial fibrillation and typical atrial flutter: systematic review and economic evaluation.
Rodgers M, McKenna C, Palmer S, Chambers D, Van Hout S, Golder S, Pepper C, Todd D, Woolacott N
Health Technol Assess 2008 Nov;12(34):iii-iv, xi-xiii, 1-198. doi: 10.3310/hta12340. PMID: 19036232

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