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Physiologically — the most commonly observed pattern of AFlutter, known as " Typical " AFlutter — produces 2:1 negative deflections seen in the inferior leads ( as seen in Figure-3 ) — as a result of CCW ( C ounter C lock W ise ) rotation of a fixed reentrant circuit around the tricuspid valve annulus and through the cavo-tricuspid isthmus.
However, underlying lesions such as hypertension, mitral valve disease, COPD, ASD, and TR greatly influence the degree of atrial enlargement. Spatial relationship of sites for atrial fibrillation drivers and atrial tachycardia in patients with both arrhythmias July 2017 International Journal of Cardiology 248(3) AF begets AF.
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