What is the pathogenesis of typical atrial flutter (AFL)?

Updated: Nov 18, 2019
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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Answer

In humans, the most common form of atrial flutter (typical) involves a single reentrant circuit with circus activation in the right atrium around the tricuspid valve annulus (most often in a counterclockwise direction), with an area of slow conduction located between the tricuspid valve annulus and the coronary sinus ostium (subeustachian isthmus). A 3-dimensional electroanatomic map of typical atrial flutter is shown in the video below.

3-Dimensional electroanatomic map of typical atrial flutter. Colors progress from blue to red to white and represent the relative conduction time in the right atrium (early to late). An ablation line (red dots) has been created on the tricuspid ridge extending to the inferior vena cava. This ablation line interrupts the flutter circuit. CSO = coronary sinus os; IVC = inferior vena cava; RAA = right atrial appendage; TV = tricuspid valve annulus.

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