The History of Atrial Flutter Electrophysiology, from Entrainment to Ablation

A 100-Year Experience in the Precision Electrocardiology
Published:August 22, 2022DOI:


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Cardiac Electrophysiology Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Saoudi N.
        • Cosio F.
        • Waldo A.
        • et al.
        A classification of atrial flutter and regular atrial tachycardia according to electrophysiological mechanisms and anatomical bases; a statement from a joint expert group from the working group of arrhythmias of the European society of cardiology and the north American society of pacing and electrophysiology.
        Eur Heart J. 2001; 22: 1162-1182
        • Marks J.
        Atrial flutter with 1:1 AV conduction.
        Arch Intern Med. 1959; 100: 989-993
        • Leonelli F.
        • Bagliani G.
        • Boriani G.
        • et al.
        Arrhythmias originating in the atria.
        Card Electrophysiol Clin. 2017; 9: 383-409
        • Lewis T.
        • Feil H.S.
        • Stroud W.D.
        Observations upon flutter, fibrillation. Part II. The nature of auricular flutter. Part III: some effects of rhythmic stimulation of the auricle.
        Heart. 1920; 7
        • Mines G.R.
        On circulating excitations in heart muscle and their possible relation to tachycardia and fibrillation.
        Trans R Soc Can. 1914; : 43-52
        • Mines G.
        On dynamic equilibrium of the heart.
        J Physiol. 1913; 46: 349-382
        • Allessie M.A.
        • Lammers W.J.E.P.
        • Bonke F.I.M.
        • et al.
        Intraatrial reentry as a mechanism for atrial flutter induced by acetylcholine and rapid pacing in the dog.
        Circulation. 1984; 70: 123-135
        • Allessie M.A.
        • Bonke F.I.
        • Schopman F.J.
        Circus movement in rabbit atrial muscle as a mechanism of tachycardia. III. The "leading circle" concept: a new model of circus movement in cardiac tissue without the involvement of an anatomical obstacle.
        Circ Res. 1977; 41: 9-18
        • Waldo A.L.
        Mechanisms of atrial fibrillation, atrial flutter, and ectopic atrial tachycardia—a brief review.
        Circulation. 1987; 75: III37-III40
        • Feld G.K.
        • Shahandeh-Rad F.
        Mechanism of double potentials recorded during sustained atrial flutter in the canine right atrial crush-injury model.
        Circulation. 1992; 86: 628-641
        • Chan D.P.
        • Van Hare G.F.
        • Mackall J.A.
        • et al.
        Importance of atrial flutter isthmus in postoperative intra-atrial reentrant tachycardia.
        Circulation. 2000; 102: 1283-1289
        • Cosio F.G.
        • Arribas F.
        • Palacios J.
        • et al.
        Fragmented electrograms and continuous electrical activity in atriai flutter.
        Am J Cardiol. 1986; 57: 1309-1314
        • Wells J.L.
        • MacLean W.A.H.
        • James T.N.
        • et al.
        Characterization of atrial flutter: studies in man after open heart surgery using fixed atrial electrodes.
        Circulation. 1979; 60: 665-673
        • Waldo A.L.
        • MacLean W.A.
        • Karp R.B.
        • et al.
        Entrainment and interruption of atrial flutter with atrial pacing: studies in man following open heart surgery.
        Circulation. 1977; 56: 737-745
        • Disertori M.
        • Inama G.
        • Vergara G.
        • et al.
        Evidence of a reentry circuit in the common type of atrial flutter in man.
        Circulation. 1983; 67: 434-440
      1. Takahiko K, Shingo S, Masaomi K .Long Postpacing Interval After Entrainment of Tachycardia Including a Slow Conduction Zone Within the Circuit. J Cardiovasc Electrophysiol, Vol. pp. 1-7.

        • Kalman J.M.
        • Olgin J.E.
        • Saxon L.A.
        • et al.
        Activation and entrainment mapping defines the tricuspid annulus as the anterior barrier in typical atrial flutter.
        Circulation. 1996; 94: 398-406
        • Nakagawa H.
        • Lazzara R.
        • Khastgir T.
        • et al.
        Role of the tricuspid annulus and the eustachian valve/ridge on atrial flutter. Relevance to catheter ablation of the septal isthmus and a new technique for rapid identification of ablation success.
        Circulation. 1996; 94: 407-424
        • Calkins H.
        • Leon A.R.
        • Deam A.G.
        • et al.
        Catheter ablation of atrial flutter using radiofrequency energy.
        Am J Cardiol. 1994; 73: 353-356
        • Willems S.
        • Weiss C.
        • Ventura R.
        • et al.
        Catheter ablation of atrial flutter guided by electroanatomic mapping (CARTO): a randomized comparison to the conventional approach.
        J Cardiovasc Electrophysiol. 2000; 11: 1223-1230
        • Mangat I.
        • Tschopp Jr., D.R.
        • Yang Y.
        • et al.
        Optimizing the detection of bidirectional block across the flutter isthmus for patients with typical isthmus-dependent atrial flutter.
        Am J Cardiol. 2003; 91: 559-564
        • Natale A.
        • Newby K.H.
        • Pisano E.
        • et al.
        Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter.
        J Am Coll Cardiol. 2000; 35: 1898-1904
        • Villacastin J.
        • Perez-Castellano N.
        • Moreno J.
        • et al.
        Left atrial flutter after radiofrequency catheter ablation of focal atrial fibrillation.
        J Cardiovasc Electrophysiol. 2003; 14: 417-421
        • De Ponti R.
        • Verlato R.
        • Bertaglia E.
        • et al.
        Treatment of macro-re-entrant atrial tachycardia based on electroanatomic mapping: identification and ablation of the mid-diastolic isthmus.
        Europace. 2007; 9: 449-457
        • Oral H.
        • Knight B.P.
        • Morady F.
        Left atrial flutter after segmental ostial radiofrequency catheter ablation for pulmonary vein isolation.
        Pacing Clin Electrophysiol. 2003; 26: 1417-1419