Atrial Flutter

An organised atrial rhythm with an atrial rate typically between 250-350bpm

Epidemiology

Much less common than atrial fibrillation

More common in men

Either paroxysmal (sudden) or persistent

Prevalence increases with age

Often associated with atrial fibrillation and frequently require a similar initial therapeutic approach

Causes

Hypertension

Heart Failure

Obesity

COPD

Coronary heart disease

Pericarditis

Idiopathic (30%)

Acute excess alcohol intoxication

Risk factors

Atrial fibrillation

Clinical Presentation

Chest pain

Dizziness

Breathlessness

Syncope (fainting)

Fatigue

Palpitations

Differential Diagnosis

Atrial Fibrillation

Supra-ventricular tachyarrhythmias

Diagnosis

Treatment

ECG

Regular saw tooth-like atrial flutter, waves (F waves) between QRS complexes due to continuous atrial depolarisation

Note: if F waves are not visible then they may be able to be unmasked by slowing atrioventricular conduction by carotid sinus massage or IV adenosine (AVN blocker)

Definitive diagnosis

Catheter ablation - creating a conduction block to try a restore rhythm and block offending re-entrant wave

IV Amiodarone to restore sinus rhythm and use a beta-blocker e.g. Bisoprolol to suppress further arrhythmias

Electrical cardioversion but anticoagulant before e.g. low molecular weight heparin e.g. Enoxaparin or Dalteparin if acute i.e. atrial flutter started less than 48 hours ago