Electrocardiographic Approach to Atrial Flutter: Classifications and Differential Diagnosis

Giuseppe Bagliani; Fabio M Leonelli; Roberto De Ponti; Michela Casella; Francesca Massara; Paolo Tofoni; Federico Guerra; Giuseppe Ciliberti; Antonio Dello Russo

doi:10.1016/j.ccep.2022.05.007

Electrocardiographic Approach to Atrial Flutter: Classifications and Differential Diagnosis

Card Electrophysiol Clin. 2022 Sep;14(3):385-399. doi: 10.1016/j.ccep.2022.05.007. Epub 2022 Aug 25.

Authors

Giuseppe Bagliani¹, Fabio M Leonelli², Roberto De Ponti³, Michela Casella⁴, Francesca Massara⁵, Paolo Tofoni⁵, Federico Guerra⁶, Giuseppe Ciliberti⁶, Antonio Dello Russo⁶

Affiliations

¹ Cardiology And Arrhythmology Clinic, University Hospital "Ospedali Riuniti", via Conca 71, 60100 Ancona, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy. Electronic address: giuseppe.bagliani@tim.it.
² Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA; University of South Florida, 4202 East Fowler Avenue, Tampa, FL 33620, USA.
³ Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy.
⁴ Cardiology And Arrhythmology Clinic, University Hospital "Ospedali Riuniti", via Conca 71, 60100 Ancona, Italy; Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy.
⁵ Cardiology And Arrhythmology Clinic, University Hospital "Ospedali Riuniti", via Conca 71, 60100 Ancona, Italy.
⁶ Cardiology And Arrhythmology Clinic, University Hospital "Ospedali Riuniti", via Conca 71, 60100 Ancona, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy.

PMID: 36153121
DOI: 10.1016/j.ccep.2022.05.007

Abstract

Atrial flutter (AFL) is a macro-reentrant arrhythmia characterized, in a 12 lead ECG, by the continuous oscillation of the isoelectric line in at least one lead. In the typical form of AFL, the oscillation is most obvious in the inferior leads, due to a macro-reentrant circuit localized in the right atrium, with the cavo-tricuspid isthmus as a critical zone.: This circuit can be activated in a counterclockwise or clockwise direction generating in II, III, and aVF leads, respectively, a slow descending/fast ascending F wave pattern (common form of typical AFL) or a balanced ascending/descending waveform (uncommon form of typical AFL). Atypical AFLs (scar-related) do not include the CTI in the circuit and show an extremely variable circuit location and ECG morphology.

Keywords: Atrial flutter; Atypical atrial flutter; Common typical atrial flutter; ECG recording; Typical atrial flutter; Uncommon typical atrial flutter.

Publication types

Review

MeSH terms

Atrial Flutter*
Catheter Ablation*
Diagnosis, Differential
Electrocardiography
Heart Atria
Humans