Key result
AF and AFL share a close mechanistic link where each frequently triggers the other.
Highlights the mechanistic inter-relationships between atrial fibrillation and atrial flutter, suggesting that rapid atrial flutter can drive fibrillatory conduction leading to atrial fibrillation.
Hypothesis-generating for AF-AFL sequencing; prospective trials needed before guiding interventions.
There is a close interrelationship between atrial fibrillation (AF) and atrial flutter (AFL). Atrial fibrillation of variable duration precedes the onset of AFL in almost all instances; during AF, the functional components needed to complete the AFL re-entrant circuit, principally a line of block (LoB) between the vena cavae, are formed; if this LoB does not form, classical AFL does not develop. In contrast, there seems to be a spectrum of atrial re-entrant circuits (drivers) of short cycle lengths (CLs) (i.e., AFL). When the CL of the AFL re-entrant circuit is so short that it will only activate portions of the atria in a 1:1 manner, the rest of the atria will be activated rapidly but irregularly (i.e., via fibrillatory conduction), resulting in AF. In short, there are probably several mechanisms of AF, 1 of which is due to a very rapid AFL causing fibrillatory conduction. All of these interactions of AF and AFL have important clinical implications.
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Waldo et al. (2008) conducted a review in Atrial fibrillation and atrial flutter. Atrial fibrillation and atrial flutter share a close mechanistic interrelationship, where AF often precedes AFL and rapid AFL can cause fibrillatory conduction resulting in AF.
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