Atrial flutter is a rapid regular atrial rhythm due to an atrial macroreentrant circuit. Symptoms include palpitations and sometimes weakness, effort intolerance. An abnormally fast heart rate is called tachycardia. Because atrial flutter comes from the atria, it is called a supraventricular (above the ventricles) tachycardia. Atrial flutter is closely related to another arrhythmia called atrial fibrillation. The two sometimes alternate back and forth. In the typical form, this entity is characterised electrocardiographically by flutter waves, which are a saw-tooth pattern of atrial activation, most prominent in leads.


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Atrial flutter

Positive forces in inferior leads and V1 will be underpowered as a consequence of the change in the typical up-down depolarisation of the lateral wall. Upper loop reentry was also described flutter atrial a circuit through a gap in the crista terminalis and then in flutter atrial posterior right atrium wall.


In this case, the leading flutter atrial front is confined to the left atrium. The most frequent left atrial flutters are perimitral, peripulmonary veins, septal, roof and posterior wall macroreentrys.

The surface electrocardiogram usually presents isoelectric baseline or low amplitude and positive regular F waves best in V1 Flutter atrial 3. During EPs, the diagnosis and an accurate characterisation of the circuit may be performed by activation and postpacing interval maps, which requires 3D navigation systems.

Atrial Flutter - Cardiovascular Disorders - MSD Manual Professional Edition

Typical atrial flutter with variable 3 to 4: This rhythm is closely related to atrial fibrillation. A classification of atrial flutter and regular atrial tachycardia according to electrophysiological mechanisms and anatomical bases. International consensus on flutter atrial and classification of atrial fibrillation.

A thrombus is most likely to form in the atrial appendages. A blood clot in the left atrial appendage is particularly important as the left side of flutter atrial heart supplies blood to the entire body through the arteries.

Thus, any thrombus material that dislodges from this side of the heart can embolize break off and travel to the brain's arteries, with the flutter atrial devastating consequence of a stroke.

Thrombus material can, of course, embolize to any other portion of the body, though usually with a less severe outcome.

  • Atrial flutter - Symptoms, diagnosis and treatment | BMJ Best Practice
  • Atrial flutter: common and main atypical forms
  • Atrial flutter: common and main atypical forms

Sudden cardiac death[ edit ] Sudden death is not directly associated with atrial flutter. However, in individuals with a pre-existing accessory conduction flutter atrial, such as the bundle of Kent in Wolff-Parkinson-White flutter atrialthe accessory pathway may conduct activity from the atria to the ventricles at a rate that the AV node would usually block.

Even if the ventricles are able to sustain a cardiac output at such flutter atrial high rates, 1: Pathophysiology[ edit ] Atrial flutter is caused by a re-entrant rhythm.


This usually occurs along the cavo-tricuspid isthmus of the right atrium though atrial flutter can originate from the left atrium as well. Typically initiated by a premature electrical impulse arising in the atriaatrial flutter is propagated due to differences in refractory periods of atrial tissue.

If flutter atrial are used to restore sinus rhythm, rate must first be controlled flutter atrial beta-blockers or nondihydropyridine calcium channel blockers eg, verapamil, diltiazem.

Atrial flutter - Wikipedia

Many of the antiarrhythmic drugs that can restore sinus rhythm especially class Ia and Ic can slow atrial flutter, shorten AV nodal refractoriness flutter atrial their vagolytic effects flutter atrial, or do both enough to allow 1: These drugs may be used for long-term maintenance as required to prevent recurrence.

An antitachycardia pacing system is an alternative to long-term use of antiarrhythmics in selected patients. Also, ablation procedures designed to interrupt the atrial reentrant circuit may effectively prevent atrial flutter, particularly typical atrial flutter.


Patients with chronic or recurrent atrial flutter require an oral anticoagulant warfarin titrated to an INR of 2 to 3, a direct thrombin inhibitor, or a factor Flutter atrial inhibitor.

The choice among the therapies is based on the same considerations as for atrial fibrillation. Key Points Atrial flutter is a rapid, regular atrial rhythm that rarely flutter atrial cause an irregular or nontachycardic QRS response, depending on the degree and type of block present.