![]() We assessed criteria for discriminating between atrial flutter and organized atrial fibrillation when using a bipolar electrode in the right atrium. Because atrial fibrillation in the right atrium can exhibit an organized pattern, it can be difficult to differentiate from atrial flutter. Contemporary atrial pacemakers incorporate pacing modes for treating atrial arrhythmias. La longitud de ciclo fue mejor parámetro diferenciador que la variación del ciclo para distinguir un aleteo auricular de una fibrilación auricular organizada. Una variación de la longitud de ciclo ≤18 ms permitió discriminar un aleteo auricular de una fibrilación auricular con una sensibilidad del 70% y una especificidad del 80%. Una longitud de ciclo ≥203 ms permitió discriminar un aleteo de una fibrilación auricular con una sensibilidad del 97% y una especificidad del 87%. La variación media de la longitud de ciclo fue menor en los grupos I y II respecto al grupo III (16 ± 7 y 13 ± 4 frente a 22 ± 7 ms, respectivamente p < 0,01). La longitud de ciclo fue mayor en los grupos I y II respecto al grupo III (232 ± 21 y 234 ± 24 frente a 183 ± 16 ms, respectivamente p < 0,001). Se midieron la longitud de ciclo media y la variación media de la longitud de ciclo en los electrogramas de aurícula derecha durante 15 s. Se obtuvieron electrogramas bipolares simultáneos de aurícula derecha e izquierda en 45 pacientes (grupo I: 15 pacientes con aleteo atípico grupo II: 15 pacientes con aleteo típico, y grupo III: 15 pacientes con fibrilación auricular organizada en la aurícula derecha). Estudiamos los criterios para discriminar un aleteo de una fibrilación auricular organizada utilizando un electrodo bipolar en la aurícula derecha. La fibrilación auricular puede tener un patrón organizado en la aurícula derecha, lo que dificulta el diagnóstico diferencial con el aleteo auricular. Los modernos dispositivos auriculares incorporan estimulación para tratar arritmias auriculares. It is important to distinguish atypical flutter from typical flutter because this tells you something about how easy the rhythm will be to control (with meds) or treat (in EP lab).Introducción y objetivos. These can have all kinds of different A wave patterns and rates. For instance, there can be a circuit that relies on the tricuspid opening and a scar or one that relies on the mitral opening and an area previously treated with ablation for afib (endless possibilities). "Atypical flutter" is any other circuit in the heart that depolarization can travel along in a self-sustaining way. In clinical practice, the distinction of whether depolarization is clockwise or counterclockwise is not very relevant (does not affect management at all) so we usually don't mention it on ECGs, etc. ![]() The depolarization can be traveling either clockwise or counterclockwise in "typical flutter" (you can even have both, at different times, in the same patient). If someone has had surgery or ablation, the rules kind of go out the window.Īs others have said, "typical flutter" is anatomically defined: it is flutter that relies on the CTI as part of its circuit. ![]() The rate can be anywhere from 200 bpm (esp if there’s a significant degree of RA dilation) up to a little over 300 bpm. If it doesn’t look typical it is still probably typical. The ECG appearance is primarily due to the vector of activation along the lateral wall of the right atrium as seen on the inferior leads and in lead V1.įrom a practical standpoint: Patients without prior surgery or ablation, if it looks typical it very likely is typical. By this time the tissue is able to conduct and then you have a beat of atrial flutter. The enters the CTI from left to right, blocks, then travels around the tricuspid valve until it reaches the CTI from the other direction. This can be using zones of slow conduction from prior surgery, ablation, or areas of diseased atrial myocardium.Ĭounterclockwise (CCW) flutter is most common because there is a higher likelihood of PACs initiating the arrhythmia from the atria to the anatomical left of the CTI. The most accurate description of an atypical flutter is a macro reentrant atrial tachycardia. The nomenclature is really unfortunate, as flutter is a description of symptoms. As someone else said, the only difference is whether the arrhythmia circuit utilizes the cavotricuspid isthmus (CTI) in typical flutter, or something else in atypical flutter. ![]()
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