What is the pathophysiology of typical clockwise 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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Typical atrial flutter can also have the opposite activation sequence (ie, clockwise activation around the tricuspid valve annulus). Clockwise atrial flutter is much less common. When the electric activity moves in a clockwise direction, the electrocardiogram (ECG) will show positive flutter waves in leads II, III, and aVF, and they may appear somewhat sinusoidal. This arrhythmia is still considered typical, isthmus-dependent flutter; it is usually called reverse typical atrial flutter.

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