ATRIAL FLUTTER Flashcards
What kind of re-entrant circuit is present in atrial flutter?
Macro-re-entrant circuit
What is the most common cardiac chamber involved in atrial flutter?
Right atrium as it has crista terminalis, pectinate muscles, tricuspid valve and eustachian ridge, all which provide an architecture that can lead to a macro-re-entrant circuit
Why is the left atrium less commonly involved in atrial flutter?
Left atrium has a smooth surface and lacks the architecture that is present in the right atrium
What is another term for Typical atrial flutter?
CTI-dependent
Cavo-tricuspid isthmus dependent
What is the most common circuit pathway for Typical (CTI-dependent) atrial flutter?
Most common is counter clockwise up the septum then down the RV free wall. It then goes through to cavo-tricuspid isthmus where transmission is slower
How does the left atrium get activated in Typical atrial flutter?
Left atrium gets passive activation through CS ostium, septum and the bachman bundle
What are the ECG findings in Typical atrial flutter?
We evaluate the inferior leads and V1
Usually saw-tooth downsloping in inferior leads and positive in V1
What do we see in EP study for Typical atrial flutter?
We see a wavefront going through the tricuspid-caval isthmus
Where do we ablate for Typical atrial flutter?
We ablate between the tricuspid valve and the IVC (Triscuspid-cavo isthmus)
What is atypical atrial flutter?
This is a macro-re-entrant circuit that is not CTI dependent
Where can we have atypical flutter?
It can be in the right or the left atrium. It does not need cavo-tricuspid isthmus
EKG findings in atypical atrial flutter?
We don’t see saw-tooth waves in inferior leads and also don’t have positivity in V1
What are risk factors for atypical flutter?
Atypical flutter can occur when there has been interventions done of the left or right atrium in the past. These include prior ablations, MV surgery or congenital heart disease
Treatment of atrial flutter?
For symptomatic patients rate or rhythm control can be pursued
Treatment of choice for Typical atrial flutter?
Cathetar ablation as it is > 95% success rate
