Atrial Flutter

Question 1

Define atrial flutter.

Answer 1

Typical atrial flutter (anti-clockwise cavotricuspid isthmus-dependent atrial flutter) is a macro-reentrant atrial tachycardia with atrial rates usually above 250 bpm up to 320 bpm.

Question 2

Explain the aetiology/risk factors of atrial flutter.

Answer 2

Increasing age
Valvular dysfunction
Atrial septal defects
Atrial dilation
Recent cardiac or thoracic procedures
Surgical or post-ablation scarring of atria
Heart failure
Hyperthyroidism
COPD
Asthma
Pneumonia

Question 3

Summarise the epidemiology of atrial flutter.

Answer 3

The overall incidence has been reported as 88/100,000 person-years, with increasing rates with older age.

Question 4

Recognise the presenting symptoms of atrial flutter. Recognise the signs of atrial flutter on physical examination.

Answer 4

Palpitations
Fatigue or lightheadedness
Jugular venous pulsations with rapid flutter waves
Chest pain
Dyspnoea
Syncope
Hypotension

Question 5

Identify appropriate investigations for atrial flutter and interpret the results.

Answer 5

ECG: In the typical form, this entity is characterised electrocardiographically by flutter waves, which are a saw-tooth pattern of atrial activation, most prominent in leads II, III, aVF, and V1.
TFTs
Serum electrolytes
CXR

Question 6

Generate a management plan for atrial flutter.

Answer 6

Synchronised cardioversion until stable.
Once stable:

1st line: Beta-blocker or CCB or amiodarone
Plus:
Anticoagulation
Treat co-existing acute disease process

Question 7

Identify the possible complications of atrial flutter and its management.

Answer 7

Myocardial ischaemia
Acute stroke

Question 8

Summarise the prognosis for patients with atrial flutter.

Answer 8

In approximately 60% of cases, atrial flutter occurs in the setting of an acute process. Once that process has been treated, sinus rhythm is usually restored and chronic therapy is not required.