• Atrial flutter is characterised by a large (macro) re-entry circuit, usually within the RA encircling the tricuspid annulus.
• The atrial rate is approximately 300/min, and is usually associated with 2:1, 3:1 or 4:1 AV block (with corresponding heart rates of 150, 100 or 75/min).
• The ECG shows saw-toothed flutter waves
• When there is regular 2:1 AV block, it may be difficult to identify flutter waves which are buried in the QRS complexes and T waves
• Atrial flutter should always be suspected when there is a narrow complex tachycardia of 150/min.
• Carotid sinus pressure or intra- venous adenosine may help to establish the diagnosis by temporarily increasing the degree of AV block and revealing the flutter waves
• Digoxin, β-blockersor verapamil can be used to control the ventricular rate However, in many cases it may be preferable to try to restore sinus rhythm by direct current (DC) cardioversion or by using intra- venous amiodarone.
• Beta-blockers or amiodarone can also be used to prevent recurrent episodes of atrial flutter.
• Although flecainide can also be used for acute treatment or prophylaxis, it should be avoided because there is a risk of slowing the flutter circuit and facilitating 1:1 AV nodal conduction. This can cause a paradoxical tachycardia and haemodynamic compromise.
• If used, it should always be prescribed along with an AV node-blocking drug, such as aBeta
• Catheter ablation offers a 90% chance of complete cure and is the treatment of choice for patients with persistent, troublesome symptoms.
Atrial flutter (AFL)
ECG: Atrial Flutter
ECG Rhythm Review: SVT, Atrial Fibrillation, Atrial Flutter
A narrated and animated review of: Supraventricular Tachycardia, Atrial Fibrillation and Atrial Flutter.
Atrial Flutter Animation
VHM v2.0 Atrial Flutter simulation
ATRIAL FLUTTER. NIK NIKAM, MD, MHA