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Europace Advance Access published online on May 2, 2008
Europace, doi:10.1093/europace/eun106
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

REVIEW

Prediction of the atrial flutter circuit location from the surface electrocardiogram

Caroline Medi1,2 and Jonathan M. Kalman1,2,*

1 Department of Cardiology, Royal Melbourne Hospital; 2 Department of Medicine, The University of Melbourne, Melbourne 3050, Victoria, Australia

Identification of atypical atrial flutter (AFL) (non-cavo-tricuspid isthmus-dependent) prior to the electrophysiology laboratory is potentially useful because it allows appropriate procedural planning and enables discussion of the likely success rates and risks of the procedure with the patient. Typical counterclockwise AFL has a stereotypic appearance, the electrocardiogram (ECG) is predictive of the diagnosis in the majority of cases, and ablation procedures are associated with a high degree of safety and success. Atypical right atrial and left AFLs have a highly variable flutter wave morphology and may appear atypical, resemble typical flutter or appear to be focal in origin. Targeting these complex and often multiple re-entrant circuits is aided by expertise and use of electroanatomic mapping systems. This review will address whether there are clues from the 12-lead ECG which assist in the localization of AFL circuits.

Key Words: Typical atrial flutter, Atypical atrial flutter, Surface electrocardiogram, P-wave morphology, Left atrial flutter

* Corresponding author. Tel: +61 3 93495400; fax: +61 3 93495411.E-mail address: jon.kalman{at}mh.org.au

Manuscript submitted 24 February 2008. Accepted after revision 2 April 2008.


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