{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T02:08:11Z","timestamp":1791338891515,"version":"4.3.1"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[1997,11,18]]},"abstract":"<jats:p>\n            <jats:italic>Background<\/jats:italic>\n            A transitional rhythm precedes the spontaneous onset of atrial flutter in an animal model, but few data are available in man.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Methods and Results<\/jats:italic>\n            In 10 patients, 16 episodes of atrial fibrillation (166\u00b1236 seconds) converting into atrial flutter during electrophysiological evaluation were analyzed. A 20-pole catheter was used for mapping the right atrial free wall. Preceding the conversion was a characteristic sequence of events: (1) a gradual increase in atrial fibrillation cycle length (150\u00b125 ms after onset, 166\u00b128 ms before conversion,\n            <jats:italic>P<\/jats:italic>\n            &lt;.01); (2) an electrically silent period (267\u00b145 ms); (3) \u201corganized atrial fibrillation\u201d (cycle length, 184\u00b124 ms) with the same right atrial free wall activation direction as during atrial flutter; (4) another delay on the lateral right atrium (283\u00b152 ms); and (5) typical atrial flutter (cycle length, 245\u00b138 ms). The coronary sinus generally had a different rate than the right atrial free wall until the beat that initiated flutter, when right atrium and coronary sinus were activated in sequence.\n          <\/jats:p>\n          <jats:p>During 1313 seconds of fibrillation, there were 171 episodes of \u201corganized atrial fibrillation.\u201d An additional activation delay at least 30 ms longer than the mean organized atrial fibrillation cycle length was sensitive (100%) and specific (99%) for impending organization into atrial flutter. During organized atrial fibrillation, right atrial free wall activation was craniocaudal in 70% and caudocranial in 30%, which may explain why counterclockwise flutter is a more common clinical rhythm than clockwise flutter. Atrial flutter never degenerated into fibrillation, even after adenosine infusion.<\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusions<\/jats:italic>\n            Anatomic barriers, along with statistical properties of conduction and refractoriness during atrial fibrillation, may explain the remarkably stereotypical pattern of endocardial activation during the initiation of atrial flutter via fibrillation and the rarity of degeneration of flutter to fibrillation once it stabilizes.\n          <\/jats:p>","DOI":"10.1161\/01.cir.96.10.3484","type":"journal-article","created":{"date-parts":[[2012,6,12]],"date-time":"2012-06-12T00:41:02Z","timestamp":1339461662000},"page":"3484-3491","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":93,"title":["Relationship Between Atrial Fibrillation and Typical Atrial Flutter in Humans"],"prefix":"10.1161","volume":"96","author":[{"given":"Franz X.","family":"Roithinger","sequence":"first","affiliation":[{"name":"From the Section of Cardiac Electrophysiology, Department of Medicine and Cardiovascular Research Institute, University of California San Francisco."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin R.","family":"Karch","sequence":"additional","affiliation":[{"name":"From the Section of Cardiac Electrophysiology, Department of Medicine and Cardiovascular Research Institute, University of California San Francisco."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul R.","family":"Steiner","sequence":"additional","affiliation":[{"name":"From the Section of Cardiac Electrophysiology, Department of Medicine and Cardiovascular Research Institute, University of California San Francisco."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arne","family":"SippensGroenewegen","sequence":"additional","affiliation":[{"name":"From the Section of Cardiac Electrophysiology, Department of Medicine and Cardiovascular Research Institute, University of California San Francisco."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Lesh","sequence":"additional","affiliation":[{"name":"From the Section of Cardiac Electrophysiology, Department of Medicine and Cardiovascular Research Institute, University of California San Francisco."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.94.3.398"},{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.92.7.1839"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.94.3.407"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.86.4.1394929"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.90.6.7994824"},{"key":"e_1_3_2_6_2","first-page":"183","volume":"140","year":"1962","unstructured":"Moe GK. On, the multiple wavelet hypothesis of atrial fibrillation. Arch Int Pharmacodyn Ther. 1962;140:183\u2013188.","journal-title":"Arch Int Pharmacodyn Ther"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.86.2.1638706"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.RES.74.5.882"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(96)00223-9"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.1997.tb00775.x"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.1978.tb03504.x"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(80)90115-0"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.101.1.34"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(91)90857-6"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/res.74.6.8187276"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(95)00459-9"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.1996.tb00467.x"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(96)00480-9"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/01.CIR.96.10.3484","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,12]],"date-time":"2024-05-12T16:32:02Z","timestamp":1715531522000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/01.CIR.96.10.3484"}},"subtitle":["Activation Sequence Changes During Spontaneous Conversion"],"short-title":[],"issued":{"date-parts":[[1997,11,18]]},"references-count":18,"journal-issue":{"issue":"10","published-print":{"date-parts":[[1997,11,18]]}},"alternative-id":["10.1161\/01.CIR.96.10.3484"],"URL":"https:\/\/doi.org\/10.1161\/01.cir.96.10.3484","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[1997,11,18]]},"assertion":[{"value":"1997-04-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"1997-08-05","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"1997-11-18","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}