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(Circulation. 2007;116:2774-2775.)
© 2007 American Heart Association, Inc.

Editorial

Atrial Fibrillation–Atrial Flutter Interactions

Clinical Implications for Ablation

Albert L. Waldo, MD

From the Department of Medicine, Division of Cardiology, Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, Ohio.

Correspondence to Albert L. Waldo, MD, University Hospitals Case Medical Center, Division of Cardiology, LKSD 3080, 11100 Euclid Ave, Cleveland, OH 44106. E-mail albert.waldo@case.edu

Key Words: Editorials • ablation • atrial flutter

An extract of the first 250 words of the full text is provided, because this article has no abstract.

An appreciation of the article by Moreira et al in the current issue of Circulation¹ requires an understanding of the close interrelationship between atrial fibrillation (AF) and atrial flutter (AFL). These authors have understood this interrelationship and applied it to their data to advance the approach to both AF and AFL ablation. Key to this understanding is the recognition that cavotricuspid isthmus (CTI)–dependent AFL almost always develops from antecedent AF of variable duration.^2–5 This is because in almost all instances, it is during the AF that a functional line of block (LoB) necessary for the development of AFL forms between the superior and inferior vena cavae. This LoB acts as a critical lateral boundary that prevents short-circuiting of the AFL reentrant circuit. Thus, in the vast majority of instances, without preceding AF, there can be no AFL. The most recent additional support of this concept comes from the report by Ellis et al,⁶ which found that of 363 patients who presented with only CTI-dependent AFL and who underwent CTI ablation, long-term follow-up (mean of 39±11 months) demonstrated newly recognized AF in 82%. It also should be noted that, as Moreira et al¹ recognize, in some patients, a LoB between the vena cavae may be fixed (ie, anatomic) rather than functional. In such patients, AF may not be required for AFL to develop.

Article p 2786

As Moreira et al¹ further recognize, their report does not answer all the questions about the interrelationships of AF and AFL as they relate to . . . [Full Text of this Article]

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Circulation 2007 116: 2773. [Extract] [Full Text]

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