Atrial Flutter



  • Atrial dysrhythmia (most commonly with atrial rate of 300 with a 2:1 block leading to a ventricular rate of 150)
  • Estimated 200,000 new cases each year
  • A macroreentrant circuit in the right atrium is thought to be the underlying mechanism
  • Most sensitive rhythm to cardioversion
  • Seldom occurs in the absence of organic heart disease
  • Less common than supraventricular tachycardia (SVT) or atrial fibrillation
  • Typically paroxysmal, lasting seconds to hours
  • Occurs in ∼25–35% of patients with atrial fibrillation
  • Untreated, may promote cardiomyopathy


  • 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 first postoperative week)
  • Thyrotoxicosis

Pediatric Considerations
  • Occurs in children but is often asymptomatic
  • Associated mortality is highest in the neonatal period
  • Associated with:
    • Congenital heart disease
    • Infectious etiologies, such as rheumatic fever or myocarditis
  • Be sure to consider potential toxic ingestions in pediatric patients with new AV block

There's more to see -- the rest of this topic is available only to subscribers.