Atrial Flutter

Question 1

What is atrial flutter?

Answer 1

Form of supraventricular tachycardia characterised by a succession of rapid atrial depolarisation waves

Question 2

What are main causes of atrial flutter?

Answer 2

• More likely to occur with pulmonary disease e.g. COPD, obstructive sleep apnoea, PE, pulmonary hypertension
• Other causes include: ischaemic heart disease, cardiomyopathy, thyroxytosis, sepsis, alcohol

Question 3

What is the underlying pathophysiology of atrial flutter?

Answer 3

• Usually paroxysmal
• Aberrant macro re-entry circuit within theright atriumwhich cycles at 300bpm
• Not all P waves make it to the ventricles so the atria ‘flutter’

Question 4

Clinical features of atrial flutter?

Answer 4

• Mostly asymptomatic
• Less commonly symptoms of arrhythmias → palpitations, dizziness, chest pain

Question 5

ECG features of atrial flutter?

Answer 5

Rhythm: regular, may be variable
- Variable block makes the rhythm appear irregular and can be hard to distinguish from AF.

P wave: “saw tooth” F wave

Narrow QRS

Question 6

Management of atrial flutter in haemodynamically unstable patients?

Answer 6

Emergency direct current synchronized cardioversion should be immediately carried out.

Question 7

Management of atrial flutter in haemodynamically stable patients?

Answer 7

If patient is haemodynamically stable then reversible causes can be treated.
- Often fluid resuscitation in septic or dehydrated patients can reverse atrial flutter into sinus rhythm.

Question 8

What can be used for rate control in hemodynamically stable atrial flutter?

Answer 8

Using an AV node blocking agent (i.e. beta blocker or calcium channel blocker).

This should be first line

Question 9

If atrial flutter fails to be controlled by rate control therapy, what is used as an alternative?

Answer 9

Cardioversion

Question 10

What is the main complication of atrial flutter?

Answer 10

Chronic atrial flutter usually progresses to atrial fibrillation