The History of Atrial Flutter Electrophysiology, from Entrainment to Ablation: A 100-Year Experience in the Precision Electrocardiology

Card Electrophysiol Clin. 2022 Sep;14(3):357-373. doi: 10.1016/j.ccep.2022.05.001. Epub 2022 Aug 22.


Atrial flutter (AFL) is a regular supraventricular reentrant tachycardia generating a continuous fluttering of the baseline electrocardiography (ECG) at a rate of 250 to 300 beats per minute. AFL is classified based on the involvement of the cavo-tricuspid isthmus in the circuit. The "isthmic" (or type 1) AFL develops entirely in the right atrium; this circuit is commonly activated in a counter-clockwise direction, generating the common sawtooth ECG morphology in the inferior leads (slow descendent-fast ascendent). AFL can be nonisthmus dependent (type 2), often presenting with faster atrial rate and most commonly a left atrial location.

Keywords: Atypical atrial flutter; Catheter ablation; Electroanatomic mapping; Precision electrocardiology; Typical atrial flutter.

Publication types

  • Review

MeSH terms

  • Atrial Flutter* / surgery
  • Cardiac Electrophysiology
  • Catheter Ablation*
  • Electrocardiography
  • Heart Atria
  • Humans