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Define atrial flutter.
Atrial flutter is a supraventricular tachyarrhythmia that is usually caused by a macroreentrant rhythm within the atria.
Describe the epidemiology.
Incidence: 88 per 100,000 person-years (increases with age)
Sex: ♂ > ♀ (incidence in men is 2.5 times greater than in women)
Describe the etiology.
Similar to atrial fibrillation (see “Etiology” section above)
May additionally result from the treatment of Afib
Describe the pathophysiology.
Type I (common; typical or isthmus-dependent flutter): caused by a counterclockwise (more common) or clockwise (less common) macroreentrant activation of cardiac muscle fibers in the right atrium that travels along the tricuspid annulus and passes through the cavotricuspid isthmus
Type II (rare; atypical atrial flutter): various reentrant rhythms that do not involve the cavotricuspid isthmus, are not well-defined, and/or occur in the left atrium
List clinical features.
Most patients are asymptomatic.
Less commonly: symptoms of arrhythmias, such as palpitations, dizziness, syncope, fatigue, and or dyspnea
Tachycardia with a regular pulse
Symptoms of the underlying disease (e.g., murmurs of mitral stenosis) may be present.
List diagnostics.
Similar to atrial fibrillation except for ECG findings (see “Diagnosis of atrial fibrillation”)
Characteristic ECG findings
Rate: typically 75–150/minute (depending on conduction) [56]
Atrial rate ≥ ventricular rate
Regular, narrow QRS complexes
The rhythm may be:
Regularly irregular if atrial flutter occurs with a variable AV block occurring in a fixed pattern (2:1 or 4:1)
Irregularly irregular with a variable block occurring in a nonfixed pattern
Sawtooth appearance of P waves: identical flutter waves (F waves) that occur in sequence at a rate of ∼ 300/minute
Describe the treatment.
Same as Afib (see “Treatment of atrial fibrillation” for further details)
Rate control: more difficult to achieve in atrial flutter than in Afib [19]
Rhythm control
Better results and lower recurrence compared to Afib [5][56]
Catheter ablation may be the most effective rhythm control strategy.
The same parameters for anticoagulation in Afib are recommended
List complications.
Frequently degenerates into atrial fibrillation
1:1 conduction leading to life-threatening ventricular tachycardia
Last changed2 years ago