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AFL is classified into typical, or cavotricuspid isthmus (CTI)\u2010dependent, and atypical, or non\u2010CTI\u2010dependent. Atypical AFL is a heterogenous group of re\u2010entrant atrial tachycardias that most commonly occur in patients with prior heart surgery or catheter ablation. The ECG pattern is poorly predictive of circuit anatomy but may still provide mechanistic insight. AFL is difficult to manage medically and catheter ablation is the preferred treatment for most patients. Recent progress in technology and clinical electrophysiology has led to detailed characterization of re\u2010entry circuits and effective ablation strategies. Combined activation and entrainment mapping are key to identifying the re\u2010entry circuit. The presence of a slow\u2010conducting isthmus, localized re\u2010entry, dual\u2010loop re\u2010entry or bystander loops may lead to misleading activation maps but can be identified by electrogram examination and entrainment mapping. In the occasional patient without inducible AFL, substrate mapping in sinus rhythm may be a viable strategy. Long\u2010term ablation success requires the creation of a transmural continuous lesion across a critical component of the re\u2010entry circuit. Procedural endpoints include bidirectional conduction block across linear lesions and non\u2010inducibility of atrial tachycardia. The present review discusses the epidemiology, mechanisms, ECG characteristics, electrophysiological characterization, and catheter ablation of atypical AFL.<\/jats:p>","DOI":"10.1111\/jce.16543","type":"journal-article","created":{"date-parts":[[2025,1,17]],"date-time":"2025-01-17T07:29:57Z","timestamp":1737098997000},"page":"2692-2711","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Atypical Atrial Flutter: Electrophysiological Characterization and Effective Catheter Ablation"],"prefix":"10.1111","volume":"36","author":[{"given":"Nicolas","family":"Johner","sequence":"first","affiliation":[{"name":"Division of Cardiology Geneva University Hospitals Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehdi","family":"Namdar","sequence":"additional","affiliation":[{"name":"Division of Cardiology Geneva University Hospitals Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6839-2192","authenticated-orcid":false,"given":"Dipen C.","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Cardiology Geneva University Hospitals Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,17]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(02)01253-6"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcha.2020.100556"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","unstructured":"N.Johner M.Namdar D. 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