Contemporary Diagnosis and Management of Atrial Flutter: A Continuum of Atrial Fibrillation and Vice Versa?

Cardiol Rev. 2017 Nov/Dec;25(6):289-297. doi: 10.1097/CRD.0000000000000162.


Atrial flutter (AFlu) is usually a fast (>240 bpm) and regular right atrial macroreentrant tachycardia, with a constrained critical region of the reentry circuit located at the cavotricuspid isthmus (CTI; typical CTI-dependent AFlu). However, a variety of right and left atrial tachycardias, resulting from different mechanisms, can also present as AFlu (atypical non-CTI-dependent AFlu). The electrocardiogram can provide clues to its origin and location; however, additional entrainment and more sophisticated electroanatomical mapping techniques may be required to identify its mechanism, location, and target area for a successful ablation. Although atrial fibrillation and AFlu are 2 separate arrhythmias, they often coexist before and after drug and/or ablation therapies. Indeed, there appears to be a close interrelationship between these 2 arrhythmias, and one may "transform" into the other. These issues are discussed in this overview, and practical algorithms are proposed to guide AFlu localization and illustrate the AFlu and atrial fibrillation continuum.

Publication types

  • Review

MeSH terms

  • Anti-Arrhythmia Agents / therapeutic use*
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / epidemiology
  • Atrial Fibrillation / therapy*
  • Atrial Flutter / diagnosis
  • Atrial Flutter / epidemiology
  • Atrial Flutter / therapy*
  • Catheter Ablation / methods*
  • Disease Management
  • Electrocardiography
  • Electrophysiologic Techniques, Cardiac
  • Humans
  • Risk Factors


  • Anti-Arrhythmia Agents