Atrial Flutter

Question 1

What is atrial flutter?

Answer 1

It is a form of supraventricular tachycardia characterised by a succession of rapid atrial depolarisation waves

Question 2

Describe the pathophysiology of atrial flutter

Answer 2

In physiological circumstances, the electrical signal passes through the atria once, stimulating a contraction then disappears through the AV node into the ventricles

In atrial flutter, the electrical signal re-circulates in a self perpetuating loop due to an extra electrical pathway in the atria

Question 3

What are the two classifications of atrial flutter?

Answer 3

Typical Atrial Flutter

Atypical Atrial Flutter

Question 4

What is typical atrial flutter?

Answer 4

It is defined as a re-entry circuit which runs anti-clockwise around the right atrium and across the cavotricuspid valve isthmus

Question 5

What is atypical atrial flutter?

Answer 5

It is defined as a re-entry circuit which runs clockwise in the right atrium, in the left atrium or around sites of previous surgery

Question 6

What four risk factors are associated with atrial flutter?

Answer 6

Hypertension

Ischaemic Heart Disease

Cardiomyopathy

Thyrotoxicosis

Question 7

What investigation is used to diagnose atrial flutter?

Answer 7

ECG Scan

Question 8

What are the four features of atrial flutter on ECG?

Answer 8

Sawtooth Appearance

Narrow QRS Complex

Tachycardia = > 150bpm

Atrial Contraction = 300bpm

Question 9

Which classification of atrial flutter lacks the sawtooth appearance on ECG scans? Which ECG feature instead indicates a diagnosis of atrial flutter?

Answer 9

Atypical Atrial Flutter

Tachycardia > 150bpm

Question 10

What is the ventricular rate of atrial flutter with 2:1 AV block?

Answer 10

150bpm

Question 11

What is the ventricular rate of atrial flutter with 3:1 AV block?

Answer 11

100bpm

Question 12

What is the management option of atrial flutter?

Answer 12

It is managed in a similar manner to atrial fibrillation - rate/rhythm control and anticoagulation

Question 13

What is an additional management option of atrial flutter - which can be curative?

Answer 13

Radiofrequency Ablation

Question 14

What is radiofrequency ablation?

Answer 14

It involves the application of heat to burn out the abnormal area of electrical activity

This leaves scar tissue that doesn’t transmit electrical activity

Question 15

In atrial flutter, which region of the heart is radiofrequency ablation conducted?

Answer 15

Triscupid valve isthmus

Question 16

What investigation is conducted prior to radiofrequency ablation?

Answer 16

Catheter Ablation

Question 17

What is catheter ablation?

Answer 17

It involves inserting a catheter into the femoral veins and feeding a wire through the venous system under x-ray guidance to the heart

Once in the heart is is placed against different areas to test the electrical signals at that point