Editorial Focal Atrial Tachycardias and Atrial Flutter: Are they Hot Enough to Make a Thematic Issue?

Focal atrial tachycardias and atrial flutter represent a considerable part of the arrhythmias treated by electrophysiologists worldwide. Antiarrhythmic drug therapy might control these arrhythmias. Unfortunately, in many cases this therapy is fraught with side effects or ar-rhythmias recur. With the advent of invasive electrophysiology, an increasing number of these substrates are becoming amenable to catheter ablation. This makes catheter ablation the better alternative of medical therapy and is therefore recommended by the currently accepted guidelines [1]. Despite the great advance in our understanding of these arrhythmias, there are still questions that remain and issues that have not been fully elucidated. This thematic issue focuses on important points and problems in the management of atrial tachycardias and flutter with specific emphasis on the challenges electrophysiologists are facing during planning and carrying out catheter ablation. Surface P wave during tachycardia is a classical tool to aid exact diagnosis and help plan the ablation strategy in cases of focal atrial tachycardias and atrial flutter. Looking at the surface ECG in an attempt to define the P wave morphology and try to pinpoint the focus location is probably the most routine thing an electrophysiologist would do before undertaking electrophysiological study and catheter ablation. But is the ECG the most accurate way to help us plan our procedure in advance? Many groups have attempted to find the best way to predict the location of atrial ectopic foci based on P wave morphology on surface ECG [2]. A detailed review of the different algorithms based on P wave morphology is presented by Lee and Fynn in the current thematic issue [3]. The matter has been presented in a very systematic way with links to arrhythmia mechanisms and specific patterns of interatrial conduction that might explain the observed morphology of P waves. The reader is drawn to the natural conclusion that P wave morphology is an important classical tool. However, there are numerous limitations of ECG that preclude its use as a sole method to guide the ablation approach. One of these limitations is spatial resolution of surface ECG that does not exceed 17 mm according to published data [4]. This makes the method inaccurate in defining the focus location in potentially ar-rhythmogenic areas located close to each other [5]. In those cases intracardiac mapping should solve the case. However when foci arise at or close to the interatrial septum biatrial mapping is frequently required. This comes …