Atrial Flutter

Basics

Description

  • Atrial dysrhythmia (atrial rate 240–360 most commonly with a 2:1 block leading to a ventricular rate of 150)
  • Estimated 200,000 new cases each year
  • Produced by a macroreentrant circuit in the right atrium above AV node in typical atrial flutter
  • Most sensitive rhythm to cardioversion
  • Uncommon in structurally normal heart
  • Less common than supraventricular tachycardia (SVT) or atrial fibrillation
  • Typically, paroxysmal, lasting seconds to hours
  • Occurs in ∼25–35% of patients with atrial fibrillation
  • Complications: MI, cardiomyopathy, heart failure, stroke, embolism, syncope

Etiology

  • Alcoholism
  • Cardiomyopathies and myocarditis
  • CHF
  • Electrolyte abnormalities
  • Ischemic heart disease
  • Pulmonary embolus and other pulm diseases
  • Valvular heart diseases
  • Post op following cardiac surgery (often in 1st postoperative week)
  • Thyrotoxicosis

Pediatric Considerations

  • Often asymptomatic
  • Mortality is highest in the neonatal period
  • Associated with congenital heart disease, cardiac surgery, tumors, channelopathies, infection, neuromuscular disease:
    • Be sure to consider potential toxic ingestions in pediatric patients with new AV block
  • In newborns, direct current cardioversion is primary therapy, BB/CCB should be avoided other than esmolol, esophageal pacing is an alternative

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