STEPUP Cardiovascular System: Tachyarrhythmias - Atrial Flutter

Question 1

How does atrial flutter begin pathophysiologically? What does the long refractory period in the AV node allow in the setting of atrial flutter?

Answer 1

1) One irritable automaticity focus in the atria fires at about 250 to 350 bpm (typically very close to 300 bpm), giving rise to regular atrial contractions
2) Atrial rate between around 300 bmp. The long refractory period in the AV node allows only one out of every two or three flutter waves to conduct the ventricles

Question 2

What are causes of atrial flutter?

Answer 2

1) Heart disease: Heart failure (most common association), rheumatic heart disease, CAD
2) COPD
3) Atrial septal defect (ASD)

Question 3

What test do you use to diagnose atrial flutter and what does this test show? Where is atrial flutter best seen on this test?

Answer 3

1) ECG provides a saw-tooth baseline, with a QRS complex appearing after every second or third “tooth” (P wave)
2) Saw-tooth flutter waves are best seen in the inferior leads (II, III, aVF)

Question 4

What is the treatment for atrial flutter?

Answer 4

Similar to treatment for AFib