Atrial flutter

Background

• Supraventricular Tachycardia
  • Atrial re-entry circuit
• Defined by atrial rate of 250-350, classically 300

Clinical Presentation

• Asymptomatic
• Palpitations
• Fatigue
• Dyspnea
• Pre-syncope/syncope

Differential Diagnosis

• Can be difficult to distinguish from atrial fibrillation

Palpitations

• Arrhythmias:
  • Narrow-complex tachycardias
  • Wide-complex tachycardias
  • AV blocks
    • Second Degree AV Block Type I (Wenckeback)
    • Second Degree AV Block Type II
    • Third Degree AV Block
  • Premature atrial contraction
  • Premature junctional contraction
  • Premature ventricular contraction
  • Sick sinus syndrome
  • Wandering atrial pacemaker
• Non-arrhythmic cardiac causes:
  • Acute coronary syndrome
  • Cardiomyopathy
  • Congenital heart disease
  • Congestive heart failure (CHF)
  • Mitral valve prolapse
  • Pacemaker complication
  • Pericarditis
  • Myocarditis
  • Valvular disease
• Psychiatric causes:
  • Panic attack
  • Anxiety
  • Somatic Symptom Disorder
• Drugs and Medications:
  • Alcohol
  • Caffeine
  • Drugs of abuse (e.g. cocaine)
  • Medications (e.g. digoxin, theophylline)
  • Tobacco
• Misc
  • Anemia
  • Hyperthyroidism
    • Thyroid storm
  • Pulmonary embolism
  • Dehydration
  • Sepsis
  • Pheochromocytoma

Diagnosis

Atrial flutter with variable block

• ECG
  • Narrow complex tachycardia
  • Atrial rate near 300
  • Flutter waves (sawtooth pattern) in inferior leads

Types

• Type 1 (Typical Atrial Flutter)
  • Re-entry circuit of right atrium (IVC and tricuspid valve)
    • Anticlockwise circuit- 90% of cases
      • Inverted flutter waves in inferior leads
      • Positive flutter waves in V1
    • Clockwise circuit
      • Positive flutter waves in inferior leads
      • Inverted flutter waves in V1
• Type 2 (Atypical Atrial Flutter)
  • Does not meet criteria for typical atrial flutter
  • Less amenable to treatment

See Also

Atrial fibrillation

References

• Rosen's