Cohen S I, Koh D, Lau S H, Rosen K M, Damato A N
Br Heart J. 1977 Feb;39(2):173-80. doi: 10.1136/hrt.39.2.173.
Atrial flutter has never been satisfactorily defined. The 'common' pattern of flutter was originally described by Lewis in 1913. Less frequently observed forms of flutter are termed 'uncommon'. Sixteen cases of the 'common' and 6 of the 'uncommon' type have been studied using isolated P loop vectorcardiography. All patients had some degree of atrioventricular block but none had evidence of digitalis excess. The atrial rates were regular and were in a range between 250 and 330/minute. Vagal manoeuvres increased AV block in each instance. All those with the 'common' type of flutter had P loops with a caudad-cephalad orientation and fifteen of the sixteen had forces which descended over the right atrium and ascended over the left atrium. The 6 cases of the uncommon type of flutter had rates which ranged between 250 and 300/minute and did not fulfil both of the criteria for 'common' flutter; namely continuous baselineu ndulation and prominent negative P deflections in the inferior leads. The cases with the 'uncommon' type of flutter had a variety of loop patterns. The most frequent type was oriented inferior slightly to the right and anterior. One patient satisfied criteria for left atrial flutter. In another the loop was oriented inferior leftward and anterior. The vectorcardiogram provides a rich source of descriptive data but does not identify the underlying mechanism(s) of flutter.
心房扑动从未得到令人满意的定义。“常见”型扑动最初由刘易斯于1913年描述。较少见的扑动形式被称为“不常见”型。使用孤立P环向量心电图对16例“常见”型和6例“不常见”型病例进行了研究。所有患者均有一定程度的房室传导阻滞，但均无洋地黄过量的证据。心房率规则，范围在每分钟250至330次之间。每次迷走神经手法操作均增加房室传导阻滞。所有“常见”型扑动患者的P环方向为尾端-头端，16例中有15例的力量在右心房下降，在左心房上升。6例“不常见”型扑动的心率范围在每分钟250至300次之间，不符合“常见”型扑动的两个标准，即基线持续波动和下壁导联显著的负向P波。“不常见”型扑动的病例有多种环型模式。最常见的类型是略向右下和前方。1例患者符合左心房扑动的标准。另一例患者的环向左下和前方。向量心电图提供了丰富的描述性数据来源，但无法识别扑动的潜在机制。
