title: [Surface ECG characteristics of right and left atrial flutter].
abstract: BACKGROUND
  Atrial tachycardia in virtually all areas of both atria has become more important in the clinical management of patients with previous complex atrial fibrillation ablation. Accurate interpretation of surface electrocardiogram (ECG) characteristics is of paramount importance to localize the origin of atrial tachycardia, particularly for planning interventional treatment. This article highlights the ECG features of different types of right and left atrial tachycardia.
  
  
  BACKGROUND
  Typical right atrial flutter through the cavotricuspid isthmus conducts septally in a cranial direction and demonstrates sawtooth-like flutter waves which start negative in II, III and aVF and then show a steep slope upwards to the isoelectric line. The flutter rate typically ranges between 240-250 beats/min. In contrast, right atrial flutter in a clockwise rotation, flutter around the vena cava inferior or superior and around a scar (e.g. after cardiac surgery) show positive or biphasic flutter waves (lower or upper loop reentry). Left atrial flutter waves (e.g. around the mitral valve or around the pulmonary veins) are very heterogeneous and are typically positive in V1 as the left atrium is located in the posterior mediastinum.
  
  
  CONCLUSIONS
  Specific knowledge of flutter wave morphology in surface ECG facilitates planning and performance of the ablation strategy.
authors.affiliation: II. Medizinische Klinik und Poliklinik, Abteilung für Elektrophysiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland, throstock@gmail.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rostock
authors.forename: Torsten
authors.initials: T
authors.lastname: Konrad
authors.forename: Sebastian
authors.initials: S
authors.lastname: Sonnenschein
authors.forename: Hanke
authors.initials: H
authors.lastname: Mollnau
authors.forename: Blanca Quesada
authors.initials: BQ
authors.lastname: Ocete
authors.forename: Karsten
authors.initials: K
authors.lastname: Bock
authors.forename: Raphael
authors.initials: R
authors.lastname: Spittler
authors.forename: Carola
authors.initials: C
authors.lastname: Huber
authors.forename: Cathrin
authors.initials: C
authors.lastname: Theis
mesh_terms: D001282:Atrial Flutter / Q000145:classification* / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods*; D019317:Evidence-Based Medicine; D006325:Heart Atria; D006801:Humans; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity