© 2002 by European Society of Cardiology
Copyright © 2002, European Society of Cardiology
Mechanisms of atrial flutter and atrial fibrillation: distinct entities or two sides of a coin?
Division of Cardiology, Department of Medicine, MS 5038, University Hospitals of Cleveland/Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106-5038, USA
* Tel.: +1-216-844-7690; fax: +1-216-844-7196 alw2@po.cwru.edu
Received 17 September 2001; accepted 12 November 2001
KEYWORDS Arrhythmia (mechanisms); Conduction (block); Impulse formation; Mapping; Supraventricular arrhythmia
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1 Introduction |
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There has been a long recognized clinical interrelationship between atrial flutter and atrial fibrillation. Patients who primarily manifest atrial flutter commonly also experience atrial fibrillation and vice versa [1,2]. Both are very common as a temporary atrial tachyarrhythmia shortly after open heart surgery, and often in the same patient [3]. And some antiarrhythmic agents, notably class IC drugs, IA drugs and amiodarone, used to suppress atrial fibrillation not uncommonly ‘convert’ recurrences of atrial tachyarrhythmia to atrial flutter [4–6]. Are these clinical associations mere coincidences, or do they reflect an important underlying similar pathophysiology and even similar mechanism(s)? Data derived largely from a series of unconnected studies in animal models and patients seemingly point to a clear interrelationship between the two, suggesting, if not indicating, that they are two sides of a coin.
Classical atrial flutter, now called typical and reverse typical atrial flutter [7], is well
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2 The mechanism of classical atrial flutter—the importance of block between the venae cavae |
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3 Components of the atrial flutter reentrant circuit in patients and their locations |
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4 Importance of atrial fibrillation to the pathogenesis of atrial flutter—its role in the development of functional block between the venae cavae |
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5 Reentrant circuits and atrial fibrillation—the role of fibrillatory conduction |
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6 Summary and conclusions |
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