Atrial Flutter

Atrial Flutter is a topic covered in the 5-Minute Emergency Consult.

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Emergency Central

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  • Atrial dysrhythmia
  • 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 1st 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

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