Typical atrial flutter with atypical flutter wave morphology due to abnormal interatrial conduction

We report a case of typical counterclockwise atrial flutter (AFL) with conduction block from right to left atrium along the coronary sinus (CS) musculature, confirmed by discontinuous CS activation sequence during pacing near the ostium and differential right atrial pacing. AFL was associated with an atypical flutter wave morphology, due to the detour of the activation wavefront from right to left atrium via alternate interatrial electrical connections, such as Bachmann’s bundle, the interatrial septum, or both. (Cardiol J 2011; 18, 4: 450–453