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Medicine (Spain) 2021年第45期13卷 2627-2631页

作者： Sánchez-Borque, P. Calero, L. Bravo Blanco, A. Miracle García-Talavera, C. Sánchez, A. Porta Rodríguez, J.A. Cabrera Campal, J.M. Rubio Servicio de Cardiología Hospital Universitario Fundación Jiménez Díaz. Universidad Autónoma de Madrid Madrid Spain Servicio de Cardiología Hospital Universitario Quirónsalud Madrid. Universidad Europea de Madrid. Pozuelo de Alarcón Madrid Spain

The term «atrial flutter» was described for the first time in animals in 1886 as rapid, regular atrial electrical activity. In 1911, its electrocardiographic characteristics were described as activity in a «rotating toothed disc» shape, distinguishing it from atrial fibrillation (AF). Currently, it is recognized as an atrial arrhythmia that is different from AF, but with similar etiopathogenic and physiopathological characteristics. © 2021

关键词： atrial fibrillation atrial flutter Clinical manifestations Diagnosis Etiopathogenesis Treatment

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atrial flutter and fibrillation in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension in the ASPIRE registry: Comparison of rate versus rhythm control approaches

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INTERNATIONAL JOURNAL OF CARDIOLOGY 2023年 371卷 363-370页

作者： Sammut, Mark Anthony Condliffe, Robin Elliot, Charlie Hameed, Abdul Lewis, Robert Kiely, David G. Kyriacou, Andreas Middleton, Jennifer T. Raithatha, Ajay Rothman, Alex Thompson, A. A. Roger Turner, Richard Charalampopoulos, Athanasios Northern Gen Hosp Dept Cardiol Sheffield England Royal Hallamshire Hosp Sheffield Pulm Vasc Dis Unit Sheffield England Univ Sheffield Dept Infect Immun & Cardiovasc Dis Sheffield England Sheffield Teaching Hosp NHS Fdn Trust Dept Crit Care Sheffield England Imperial Coll Healthcare Trust Dept Resp Med London England

Background: The development of atrial flutter and fibrillation (AFL/AF) in patients with pre-capillary pulmonary hypertension has been associated with an increased risk of morbidity and mortality. Rate and rhythm control strategies have not been directly compared. Methods: Eighty-four patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmo-nary hypertension (CTEPH) with new-onset AFL/AF were identified in the ASPIRE registry. First, baseline characteristics and rates of sinus rhythm (SR) restoration of 3 arrhythmia management strategies (rate control, medical rhythm control and DC cardioversion, DCCV) in an early (2009-13) and later (2014-19) cohort were compared. Longer-term outcomes in patients who achieved SR versus those who did not were then explored. Results: Sixty (71%) patients had AFL and 24 (29%) AF. Eighteen (22%) patients underwent rate control, 22 (26%) medical rhythm control and 44 (52%) DCCV. SR was restored in 33% treated by rate control, 59% medical rhythm control and 95% DCCV (p < 0.001). Restoration of SR was associated with greater improvement in functional class (FC) and Incremental Shuttle Walk Distance (p both <0.05). It also independently predicted superior survival (3-year survival 62% vs 23% in those remaining in AFL/AF, p < 0.0001). In addition, FC III/IV independently predicted higher mortality (HR 2.86, p = 0.007). Right atrial area independently predicted AFL/ AF recurrence (OR 1.08, p = 0.01). DCCV was generally well tolerated with no immediate major ***: Restoration of SR is associated with superior functional improvement and survival in PAH/CTEPH compared with rate control. DCCV is generally safe and is more effective than medical therapy at achieving SR.

关键词： Arrhythmias atrial fibrillation atrial flutter Pulmonary hypertension Survival WHO functional class

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Traumatic brain injury is associated with the subsequent risk of atrial fibrillation or atrial flutter

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HEART RHYTHM 2025年第3期22卷 661-667页

作者： Stewart, Ian J. Howard, Jeffrey T. Amuan, Megan E. Kennedy, Eamonn Balke, John E. Poltavskiy, Eduard Walker, Lauren E. Haigney, Mark Pugh, Mary Jo Uniformed Serv Univ Hlth Sci Dept Med Bethesda MD USA Uniformed Serv Univ Hlth Sci Mil Cardiovasc Outcomes Res Program Bethesda MD USA Univ Texas San Antonio Dept Publ Hlth San Antonio TX USA Mil & Hlth Res Fdn Laurel MD USA VA Salt Lake City Hlth Care Syst Informat Decis Enhancement & Analyt Sci IDEAS Ctr Innovat Salt Lake City UT USA Univ Utah Sch Med Dept Internal Med Div Epidemiol Salt Lake City UT USA Metis Fdn San Antonio TX USA

Background Traumatic brain injury (TBI) is associated with a variety of adverse long-term outcomes and increases sympathetic nervous system activation, which could increase the risk of arrhythmias including atrial fibrillation or atrial flutter (AF/AFL). Objective We examined episodes of TBI and subsequent AF/AFL in a large cohort of post-9/11 servicemembers and veterans. Methods The variable of interest was TBI, stratified by severity (mild, moderate/severe, and penetrating). The outcome was a subsequent diagnosis of AF/AFL. We used Fine-Gray competing risks models to evaluate the potential risk imparted by TBI on subsequent AF/AFL. Results Of the 1,924,900 participants included in the analysis, 369,891 (19.2%) experienced an episode of documented TBI. Most were young (63% <35 years), male (81.7%), and non-Hispanic White (62.7%). AF/AFL was diagnosed in 22,087 patients. On univariate analysis, only penetrating TBI (hazard ratio [HR], 2.02;95% confidence interval [CI], 1.84-2.23;P < .001) was associated with AF/AFL compared with veterans without TBI. After adjustment in the full multivariable model (adjusted for age, sex, race and ethnicity, service branch, rank, component, and comorbidities), mild (HR 1.27, 95% CI 1.22-1.32;P < .001), moderate/severe (HR, 1.34;95% CI, 1.24-1.44;P < .001), and penetrating TBI (HR, 1.82;95% CI, 1.65-2.02;P < .001) were significantly associated with AF/AFL compared with no TBI. Post hoc analyses demonstrated that the risk of AF/AFL was concentrated in female and younger patients. Conclusion We found that an episode of TBI, particularly penetrating TBI, significantly increased the risk for AF/AFL. Further work is needed to delineate the long-term risk of arrhythmias after TBI.

关键词： Traumatic brain injury atrial fibrillation atrial flutter Arrhythmias Combat injury

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An Alternative Strategy for Treating Typical atrial flutter Using a Superior Approach

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JACC-CLINICAL ELECTROPHYSIOLOGY 2025年第3期11卷 642-647页

作者： Ishikura, Masahiro Kawase, Yoshiaki Kamiya, Hiroki Miyake, Taiji Matsuo, Hitoshi Gifu Heart Ctr Dept Cardiol 4-14-4 Yabutaminami Gifu Gifu 5008384 Japan

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Typical atrial flutter: A Practical Review

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JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY 2025年第0期

作者： Johner, Nicolas Namdar, Mehdi Shah, Dipen C. Geneva Univ Hosp Cardiol Div Geneva Switzerland

Typical atrial flutter (AFL), defined as cavotricuspid isthmus (CTI)-dependent macro-re-entrant atrial tachycardia, often causes debilitating symptoms, and is associated with increased incidence of atrial fibrillation, stroke, heart failure, and death. Typical AFL occurs in patients with atrial remodeling and shares risk factors with atrial fibrillation. It is also common in patients with a history of prior heart surgery or catheter ablation. It is characterized by a recognizable ECG pattern that is highly predictive of CTI-dependent re-entry in patients without iatrogenic atrial scars. Typical AFL is difficult to manage medically due to poor efficacy of rate-controlling and antiarrhythmic drugs. Catheter ablation has been established in randomized trials to be superior to medical management in terms of safety, efficacy, and clinical outcomes including hospitalization and quality of life. Catheter ablation aims at achieving bidirectional conduction block across the CTI, which can be efficiently assessed by well-established techniques such as differential pacing. Long-term ablation success requires creating a stable transmural and continuous lesion, which can be optimized by systematic assessment of ablation parameters and lesion contiguity. The present review discusses the epidemiology, mechanisms, ECG characteristics, medical management, and catheter ablation of typical AFL.

关键词： atrial flutter atrial tachycardia catheter ablation cavotricuspid isthmus differential pacing typical atrial flutter

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Atypical atrial flutter: Electrophysiological Characterization and Effective Catheter Ablation

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JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY 2025年第0期 2025 Jan 17页

作者： Johner, Nicolas Namdar, Mehdi Shah, Dipen C. Geneva Univ Hosp Div Cardiol Geneva Switzerland

atrial flutter (AFL), defined as macro-re-entrant atrial tachycardia, is associated with debilitating symptoms, stroke, heart failure, and increased mortality. AFL is classified into typical, or cavotricuspid isthmus (CTI)-dependent, and atypical, or non-CTI-dependent. Atypical AFL is a heterogenous group of re-entrant atrial tachycardias that most commonly occur in patients with prior heart surgery or catheter ablation. The ECG pattern is poorly predictive of circuit anatomy but may still provide mechanistic insight. AFL is difficult to manage medically and catheter ablation is the preferred treatment for most patients. Recent progress in technology and clinical electrophysiology has led to detailed characterization of re-entry circuits and effective ablation strategies. Combined activation and entrainment mapping are key to identifying the re-entry circuit. The presence of a slow-conducting isthmus, localized re-entry, dual-loop re-entry or bystander loops may lead to misleading activation maps but can be identified by electrogram examination and entrainment mapping. In the occasional patient without inducible AFL, substrate mapping in sinus rhythm may be a viable strategy. Long-term ablation success requires the creation of a transmural continuous lesion across a critical component of the re-entry circuit. Procedural endpoints include bidirectional conduction block across linear lesions and non-inducibility of atrial tachycardia. The present review discusses the epidemiology, mechanisms, ECG characteristics, electrophysiological characterization, and catheter ablation of atypical AFL.

关键词： atrial flutter atrial tachycardia atypical atrial flutter catheter ablation electroanatomical mapping entrainment mapping macro-re-entrant atrial tachycardia re-entry

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Estimates and trends in death and disability from atrial fibrillation/atrial flutter due to high sodium intake, China, 1990 to 2019

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BMC CARDIOVASCULAR DISORDERS 2025年第1期25卷 1-10页

作者： Yu, Qingwen Zhao, Lijun Tang, Ting Xin, Ziyi Feng, Lanlan Rao, Xiyun Shi, Yongmin Tong, Xuhan Hu, Siqi You, Yao Zhang, Shenghui Tang, Jiake Cheng, Yongran Zhang, Xingwei Wang, Mingwei Li, Ximin Hangzhou Normal Univ Affiliated Hosp Hangzhou Inst Cardiovasc Dis Engn Res Ctr Mobile Hlth Management SystDept Card Hangzhou 310015 Peoples R China Hangzhou Normal Univ Minist Educ Hangzhou 310015 Peoples R China Hangzhou Med Coll Zhejiang Prov Peoples Hosp Affiliated Peoples Hosp Canc CtrDept Nucl Med Hangzhou Peoples R China Hangzhou Med Coll Sch Publ Hlth Hangzhou 311300 Peoples R China Jiande First Peoples Hosp Hangzhou 311600 Peoples R China

Objective The effect of sodium intake on atrial fibrillation (AF)/atrial flutter (AFL), with respect to sex and age, has yet to be elucidated. This study aims to compare long-term trends in AF/AFL death and disability due to high sodium intake in China from 1990 to 2019. Methods We utilized data from the Global Burden of Disease study to assess the mortality and disability burden of AF/AFL attributable to high sodium intake (> 5 g/d) in China from 1990 to 2019. Overtime trends and average annual percentage change (AAPC) were analyzed with adjustments for age, sex, period, and cohorts. Results In 2019, the number of AF/AFL deaths and disability-adjusted life years attributable to high sodium intake were 4209.944 (95% UI: [1250.690-8718.238]) and 235484.586 (95% UI: [89136.783-428566.694]), with males comprising 44.81% and 51.95% of cases, respectively. The age-standardized mortality rates (ASMRs) and age-standardized disability rates (ASDRs) of AF/AFL attributable to high sodium intake exhibited downward trends from 1990 to 2019 in China. The AAPC was - 0.221(95% CI: -0.321-0.121)and - 0.631(95% CI: -0.816-0.446) for AF/AFL, respectively. An upward trend was observed in ASMRs for AF and AFL, attributable to high sodium intake due to high salt intake at ages 30-34, 35-39, and 40-44. With an increase in age, the AAPC for ASMRs increased correspondingly, and the AAPC for ASDRs exhibited a decreasing trend. Conclusions Our findings provide strong evidence that high sodium levels in China significantly affect standard ASMRs and ASDRs for AF and AFL. Notably, different patterns of change are identified across various age groups, emphasizing the pronounced effect of salt reduction on AF and AFL.

关键词： atrial fibrillation atrial flutter High sodium intake Burden of disease China

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Burden of atrial Fibrillation and atrial flutter From 1990 to 2021 in China: Global Burden of Disease Study 2021 Update

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PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 2025年第4期48卷 447-454页

作者： Kong, Xiangyi Li, Mingxiao He, Liu Lai, Yiwei Wang, Jue Li, Sitong Peng, Xiaodong Zhao, Manlin Li, Qifan Zhao, Zixu Zhou, Le Yang, Zejun Shen, Ting Zhao, Meiqi Wang, Zhixian Li, Enze Zhao, Yize Wang, Wenyu Xia, Shijun Jiang, Chao Guo, Xueyuan Zhou, Ning Du, Xin Sang, Caihua Dong, Jianzeng Ma, Changsheng Capital Med Univ Beijing Anzhen Hosp Natl Clin Res Ctr Cardiovasc Dis Dept Cardiol Beijing Peoples R China Heart Hlth Res Ctr Beijing Peoples R China

Backgroundatrial fibrillation (AF) and atrial flutter (AFL) represent increasingly significant health burden globally. We aimed to systematically evaluate the status and trends of AF/AFL burden and attributable risk factors in *** assessed the burden of AF/AFL measured as prevalence, incidence, mortality, and disability-adjusted life years (DALYs), by sex and age groups in China based on the Global Burden of Diseases Study (GBD) 2021 *** China, there were 10,775.72 thousand AF/AFL prevalent cases, 916.18 thousand AF/AFL incident cases, and 64.73 thousand AF/AFL mortality cases, contributing to 1653.12 thousand DALYs due to AF/AFL in 2021. Trend analysis indicated that the AAPC of number and crude rates of prevalence, incidence, mortality, and DALYs all escalated from 1990 to 2021. The current AF/AFL burden and temporal trend between 1990 and 2021 displayed heterogeneity based on sex and age groups. The spectrum for risk factors attributed for DALYs due to AF/AFL presented sex- and age-specific manifestation. High systolic blood pressure served as the emerging leading contributor to DALYs due to AF/AFL in *** significant increase in the burden of AF/AFL underscores the enduring public health burden of AF/AFL in China, marked by profound sex and age-related variations. There is a pressing imperative to adopt tailored strategies to attenuate increasing burden of AF/AFL and combat alongside high complication burden due to AF/AFL in China.

关键词： atrial fibrillation atrial flutter Global Burden of Disease population attributable fraction trend analysis

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Severity of Left Ventricular Dysfunction in Patients With Tachycardia-Induced Cardiomyopathy: Impacts on Remodeling After atrial flutter Ablation

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AMERICAN JOURNAL OF CARDIOLOGY 2024年 213卷 132-139页

作者： De Larochellie, Hugo Brouillette, Francois Levesque, Patrick Dognin, Nicolas St-Germain, Raphael Rimac, Goran Lemay, Sylvain Philippon, Francois Senechal, Mario Univ Laval Inst Univ Cardiol & Pneumol Quebec IUCPQ Div Cardiol Quebec City PQ Canada

Tachycardia-induced cardiomyopathy is defined as a reversible left ventricular (LV) systolic dysfunction (SeD) resulting from a sustained fast heart rate. LV remodeling in patients with severe LV dysfunction at diagnosis remains poorly understood. In this retrospective cohort study, we described LV remodeling in 50 patients who underwent atrial flutter ablation. These patients were divided into severe LV SeD (LV ejection fraction [EF] <= 30%) and LV nonsevere SeD (LVEF 31% to 50%) at baseline. All continuous variables are expressed as median and interquartile range. LVEF was 18% (13 to 25) and 38% (34 to 41) in the SeD (n = 29) and LV nonsevere SeD (n = 21) groups, respectively. At baseline, patients with SeD had higher LV end-diastolic diameter (56 [54 to 59] vs 49 mm [47 to 52], p <0.01), LV end-systolic diameter (48 [43 to 51] vs 36 mm [34 to 41], p <0.01), LV end-diastolic volume (71 [64 to 85] vs 56 ml/m(2) [46 to 68], p <0.01), LV end-systolic volume (56 [53 to 70] vs 36 ml/m(2) [27 to 42], p <0.01), and lower tricuspid annular plane systolic excursion (12 [10 to 13] vs 16 mm [13 to 19], p <0.01). At last follow-up, LVEF was not statistically significantly different between groups. However, LV end-systolic diameter (36 [34 to 39] vs 32 mm [32 to 34], p = 0.01) and LV end-systolic volume (29 [26 to 35] vs 25 ml/m(2) [20 to 29], p = 0.02) remained larger in the SeD group. Seven patients (14%), all from the SeD group, had a LVEF <= 35% 2 months after rhythm control, and reverse remodeling was observed up to 9 months. In conclusion, more than half of patients with tachycardia-induced cardiomyopathy and atrial flutter had LVEF <= 30% at baseline. LVEF recovery and LV remodeling were observed beyond 2 months, highlighting the importance of rhythm control and early guideline-directed medical therapy in these patients.

关键词： ablation atrial flutter remodeling tachycardia-induced cardiomyopathy

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Dual linear lesions for right atrial flutter after mitral valve surgery via the superior transseptal approach

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JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY 2024年第3期67卷 579-587页

作者： Makita, Toshio Kuwahara, Taishi Takahashi, Kenta Nakagawa, Hirofumi Nabuchi, Akihiro Ito, Yayoi Oyagi, Yoshimi Kadono, Kenta Oshio, Takuya Takahashi, Ryo Tokyo Heart Rhythm Clin Dept Cardiol 3-20-1 KasuyaSetagaya Ku Tokyo Tokyo 1570063 Japan Showa Univ Dept Cardiovasc Surg Dept Clin Diagnost Pathol Northern Yokohama Hosp 35-1 Chigasaki ChuoTsuzuki Ku Yokohama Kanagawa 2248503 Japan Tokyo Heart Rhythm Clin Dept Clin Engn & Nursing 3-20-1 Kasuya Tokyo Tokyo 1570063 Japan

BackgroundThe superior transseptal approach (STA) for mitral valve surgery is associated with a higher risk of developing macroreentrant incisional atrial flutter (AFL) than the left atrial approach. This study aimed to describe the linear lesions for the complex AFL circuit after the STA and to propose an option for the linear ablation target *** the 26 patients who underwent radiofrequency catheter ablation for AFL after mitral valve surgery, data from seven patients with STA incisions were retrospectively *** patients who had undergone the STA had incisional AFL rotated in a long loop within the right atrium (RA) and cavo-tricuspid isthmus (CTI)-dependent AFL. The linear lesions were created in the CTI, the superior RA vestibule, and between the RA-free wall incision or the septal incision and the inferior vena cava. Procedural success was achieved with dual linear lesions in the CTI and superior RA vestibule. Two of seven patients had AFL recurrence during a mean observation period of 22.5 & PLUSMN;16.7 months. The circuits of recurrent AFL were CTI-dependent AFL and perimitral AFL, respectively. No AFL recurrence was noted with reconduction of the superior RA vestibular *** linear lesions in the CTI and superior RA vestibule are an effective treatment option for RA macroreentrant AFL after the STA.

关键词： atrial flutter Catheter ablation Mitral valve surgery Superior transseptal approach Right atrial vestibule

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