Electrophysiologic studies using activation mapping and programmed stimulation indicate that common atrial flutter is produced by a large right atrial reentry circuit that can be entrained by pacing.
The clinical electrophysiologic approaches to atrial flutter (F) have been activation mapping and the observation of changes induced by programmed stimulation. Sequential endocardial activation mapping has recently yielded information indicating that common F is produced by a large right atrial (RA) reentry circuit, with counterclockwise rotation in the frontal plane, including the inferior vena cava in its center. Functional block in the crista terminalis and conduction slowing in the approaches to the atrioventricular node seem to be important to support reentry. F inscribing positive deflections in the inferior leads usually follows the same path, but in a clockwise direction. Atypical F may be produced by left atrial circuits. Atrial stimulation during F entrains the circuit, resetting it with each stimulus. Collision between antidromic and orthodromic activation during entrainment produces fusion that can be identified in the surface electrocardiogram. The last paced activation restarts F, unless circuit penetration has been enough to modify it by block or disorganization. Entrainment may result in F acceleration, with changes in activation sequence, suggesting a different type of reentry, possibly based on functional factors.
Cosío et al. (Tue,) conducted a review in Atrial flutter. Electrophysiologic studies (activation mapping and programmed stimulation) was evaluated. Electrophysiologic studies using activation mapping and programmed stimulation indicate that common atrial flutter is produced by a large right atrial reentry circuit that can be entrained by pacing.