Most people probably do not remember the slide rule, yet for years this tool was systematically used for calculations. However, the electronic calculator has completely replaced it in the world of mathematics. Similarly, we believe that we are evolving toward a new electrophysiology paradigm, guided by automatic computer-guided detection, localization, and diagnosis of cardiac arrhythmias, enabling personalized non-invasive and invasive treatments.

Entrainment is particularly troublesome for atypical atrial flutter since it can often provide misleading information or terminate the clinical arrhythmia. While entrainment still has a role in the diagnosis of atypical atrial flutter, we do not believe this is crucial for an effective ablation procedure. In our study, none of our patients underwent entrainment maneuvers for critical isthmus localization, yet all arrhythmias were effectively treated.

We thank the authors of the editorial1 for recognizing our three-dimensional electrophysiological triad as a new tool that identifies the atypical atrial flutter isthmus, and we expect that it will prove to be useful and be acknowledged as a new step toward safer, faster and more successful electrophysiology in all scar-related macroreentrant tachycardias.