Functional or structural?
Least but not last is the evaluation of the underlying substrate that
can lead to the clinical appearance of AFL. Atrial myopathy is
the phrasing to highlight the presence of a progressive atrial disease
which promotes areas of fibrosis and scars. If one considers that
patients in AFL group were older and with larger atrial volume, it is
conceivable that the myopathic process influences the conduction
properties of the atrium and, thus it is not surprising to find
prolonged RACT. Comorbidities such as systemic hypertension, OSA,
ischemic disease can greatly affect the cardiac electrophysiology and
specifically of the atrium; these pathologic clinical aspects were
significantly associated to the AFL patients suggesting an undoubtable
role in favoring the formation of the ideal pathophysiological substrate
for reentry circuits.
After several decades of investigational studies and a great wealth of
data collected about the typical atrial flutter, we are still here to be
nicely fascinated by the basic electrophysiology and surprised of how
much is still to be learned as to improve our understanding of this
common cardiac arrhythmia. In the era dominated by novel technologies
and sophisticated softwares supporting 3D mapping systems used in many
EP labs, the continuous investigation of the electrophysiologic
properties of cardiac tissue should not be disregarded. but carefully
stewarded.