Pathophysiology of Atrial Flutter

Atrial flutter is a macroreentrant tachyarrhythmia most often contained within the right atrium. Typical atrial flutter is defined on an electrocardiogram by the classic “sawtooth” pattern of flutter waves with negative polarity in leads II, III, and aVF. In contrast to atrial fibrillation, which is sustained by multiple reentrant wavelets defined by anatomic and/or functional barriers, typical atrial flutter is sustained by a single reentrant circuit defined by anatomical barriers. The isthmus of atrial tissue bordered by the inferior vena cava and the tricuspid annulus forms a critical zone of slow conduction in the reentry circuit of atrial flutter. The goal of radiofrequency catheter ablation is to create a line of conduction block across this isthmus. This line of block interrupts the flutter circuit and often provides long-term freedom from recurrence.