atrial flutter

Question 1

what is atrial flutter

Answer 1

form of SVT characterised by a succession of rapid atrial depolarisation waves

Question 2

what are the most common causes of atrial flutter in the developed world

Answer 2

hypertension
heart failure

Question 3

list causes of atrial flutter

Answer 3

hypertension
heart failure

MI
hyperthyroidism
rheumatic heart disease
sepsis
electrolyte disturbances
2-10% idiopathic

Question 4

what proportion of atrial flutter are idiopathic

Answer 4

2-10%

Question 5

pathophysiology of atrial flutter

Answer 5

usually paroxysmal
sustained by a micro-re entrant circuit
not all p waves are transmitted to the ventricles - hence flutter

Question 6

describe the clinical presentation of atrial flutter

Answer 6

mostly asymptomatic
less commonly: has symptoms of arrhythmia e.g. palpitation

Question 7

what are the investigations indicated in atrial flutter

Answer 7

ECG

Question 8

describe the ECG findings in atrial flutter

Answer 8

rate: atrial 300bmp, ventricular usually 150bmp
saw tooth F wave in place of P wave
normal QRS
regular rhythm but may be variable

Question 9

what is the management for atrial flutter

Answer 9

management of a symptomatic acute paroxysm is by cardioversion (either DCCV or pharmacological)

treatment of choice is radiofrequency catheter ablation

other options include class III anti-arrhythmics and AVN blocking agents

Question 10

what should happen to patients who have been in atrial flutter for more than 1-2 days prior to cardioversion

Answer 10

anticoagulation for 3 weeks

Question 11

what are the complications of atrial flutter

Answer 11

chronic atrial flutter usually progresses for atrial fibrillation