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J Am Coll Cardiol. 2008 Feb 26;51(8):779-86. doi: 10.1016/j.jacc.2007.08.066.

Inter-relationships of atrial fibrillation and atrial flutter mechanisms and clinical implications.

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Department of Medicine, Division of Cardiovascular Medicine, Case Western Reserve University/University Hospitals of Cleveland Case Medical Center, Cleveland, Ohio 44106-5038, USA.


There is a close interrelationship between atrial fibrillation (AF) and atrial flutter (AFL). Atrial fibrillation of variable duration precedes the onset of AFL in almost all instances; during AF, the functional components needed to complete the AFL re-entrant circuit, principally a line of block (LoB) between the vena cavae, are formed; if this LoB does not form, classical AFL does not develop. In contrast, there seems to be a spectrum of atrial re-entrant circuits (drivers) of short cycle lengths (CLs) (i.e., AFL). When the CL of the AFL re-entrant circuit is so short that it will only activate portions of the atria in a 1:1 manner, the rest of the atria will be activated rapidly but irregularly (i.e., via fibrillatory conduction), resulting in AF. In short, there are probably several mechanisms of AF, 1 of which is due to a very rapid AFL causing fibrillatory conduction. All of these interactions of AF and AFL have important clinical implications.

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