The History of Atrial Flutter Electrophysiology, from Entrainment to Ablation: A 100-Year Experience in the Precision Electrocardiology

: Atrial flutter (AFL) is a regular supraventricular reentrant tachycardia generating a continuous fluttering of the baseline electrocardiography (ECG) at a rate of 250 to 300 beats per minute. AFL is classified based on the involvement of the cavo-tricuspid isthmus in the circuit. The "isthmic" (or type 1) AFL develops entirely in the right atrium; this circuit is commonly activated in a counter-clockwise direction, generating the common sawtooth ECG morphology in the inferior leads (slow descendent-fast ascendent). AFL can be nonisthmus dependent (type 2), often presenting with faster atrial rate and most commonly a left atrial location.