Atrial Flutter Variants

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Lower Loop Reentry

• There is no Cristae Terminalis block
• There may be alteration in p wave polarity from positive to negative.
• Demonstrate concealed entrainment from the posterior RA

Partial Isthmus dependent flutter

• There is no eustacian ridge block.
• There is concealed entrainment frm the lateral CTI but not from the medial.
• Ablate from CS ostium to IVC

Atrial Flutter Entrainment

1. Pace at High RA if PPI <50 then tachycardia involves RA
2. Next pace at CS proximal PPI < 50 then tachycardia is likely a typical flutter if PPI was >50 in the right atrium
3. If High RA PPI is > 50 and CS proximal PPI < 50 then pace at CS distal if PPI < 50. If so then tachycardia involves mitral valve
4. If PPI at CS distal >50 then tachycardia involves right pulmonary veins or septum
5. If High RA PPI >50, proximal CS PPI >50, and distal PPI < 50 then tachycardia involves Left Pulmonary Veins