In our website we have a CHA 2DS 2-VASc score calculator available to help you assess the need for Anticoagulant treatment in patients with atrial flutter or atrial fibrillation.Īfter catheter ablation, anticoagulation treatment can be suspended after 4-6 weeks if the patient continues in sinus rhythm. However, chronic anticoagulation treatment is recommended following the same guidelines as with atrial fibrillation patients 1 2. Stroke risk associated to atrial flutter is slightly lower than that of atrial fibrillation. This is a procedure that causes the interruption of the macro-reentry cycle, and has high success rates and few medical complications. The definitive typical flutter treatment is the cavotricuspid isthmus catheter ablation. Options for acute, stable patients include heart rate control treatment with beta-blockers or verapamil. The most effective flutter treatment is electrical cardioversion, although it is usually used during acute episodes in patients with hemodynamic instability. Ibutilide is the most efficient antiarrhythmic drug for the cardioversion of atrial flutter in 80% of cases, but there is up to a 4% risk of torsades de pointes and a 4.9% risk of monomorphic ventricular tachycardia, so it is necessary to monitor the patient during administration 4. Pharmacotherapy to revert flutter back to sinus rhythm is not very effective.įurthermore, antiarrhythmic treatments class I can slow down atrial rates and therefore prompt 1:1 atrioventricular conduction, causing very high ventricular rates (200 bpm or higher) and clinical manifestations similar to those of ventricular tachycardia. It is less common than typical atrial flutter and even though it is also caused by a macro-reentry mechanism, this is produced in different structures as those described in the typical atrial flutter.Ītypical atrial flutter have less clear causes, sometimes secondary to previous heart surgery or atrial ablation procedures.Įlectrocardiographically it is more difficult to classify since heart rate is more variable and “saw-tooth” waves are not clearly shown. Positive flutter waves in lead II Atypical Atrial Flutter Also, it usually causes undulations of the isoelectrical segments, acting as a diagnostic aid in high heart rates. It is usually visualised between the T wave and the following QRS complex. Its main feature is a slow descending start, followed by a fast descending phase turning into a fast rise, finishing above the isoelectric line while connecting with the beginning of the following wave (creating thus the “saw-teeth” shape) 3. It owns its name to its morphology in the EKG leads where it is predominantly negative. This wave is characteristic of the atrial flutter, especially recognisable in the typical atrial flutter (see below). As such, it can be mistaken for atrial fibrillation, but it is differentiated by the “saw-tooth” waves.
In certain cases, it is arrhythmic and the conduction may be variable.
The QRS complex is narrow, except with previous bundle branch blocks or aberrant conduction ( Ashman phenomenon). There are no existing P waves, although atrial waves with “saw-tooth” pattern are spotted with rates around 300 bpm.
Atrial flutter is distinguishable on the electrocardiogram because it is a rhythmic tachycardia with heart rates that are divisors of 300 bpm, 150 bpm being the most frequent in untreated patients (AV conduction ratio 2:1).
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