Findings of congestive heart failure may be present depending on the ventricular rate, duration of atrial flutter and other factors. On physical examination, the heart rhythm will be frequently tachycardic and usually regular but, as above, may be irregularly irregular if variable conduction is present. In this situation, giving adenosine will transiently slow the ventricular rate, unmasking the atrial flutter waves and allowing a more definitive diagnosis to be made. When the heart rate is significantly elevated ― that is, greater than 150 bpm ― it is frequently difficult to differentiate atrial flutter from atrial fibrillation, atrial tachycardia or atrioventricular nodal reentrant tachycardia, or AVNRT. The classic “sawtooth” pattern occurs, as the reentrant circuit around the tricuspid valve is large, resulting in high-amplitude P waves. Diagnosis – Atrial Flutterĭiagnosing atrial flutter is done predominantly on the surface ECG. The exact proportion of atrial flutter caused directly by OSA remains unclear. Historically, hypertension was thought to be the most common cause of atrial flutter however, obstructive sleep apnea is present in about 40% of patients, and it is well known that OSA causes hypertension. Rheumatic valvular disease (specifically mitral stenosis or mitral regurgitation)Īnemia, alcohol (“holiday heart”), advanced age, autonomic tone (vagally-mediated atrial fibrillation)Įlevated blood pressure (hypertension), electrocution Ischemic heart disease, idiopathic (“lone AF”), intravenous central line (in right atrium) Pulmonary embolus, pulmonary disease, post-operative, pericarditis The classic mnemonic “PIRATES” encompases a vast majority of the causes: Identifying the etiology of cannot be under-emphasized, as treating the cause is frequently necessary to eliminate recurrences of atrial flutter. The etiology of atrial flutter is similar to that of atrial fibrillation. This appears as positively-directed flutter waves in the inferior leads.Ītypical atrial flutter originates from the left atrium or areas in the right atrium (such as surgical scars) and has a variable appearance on ECG in regards to the flutter waves. At times, the direction of the circuit can reverse, causing clockwise atrial flutter from the same anatomical location. This results in negatively-directed flutter waves in the inferior leads. Typical atrial flutter is counterclockwise in direction and originates from a reentrant circuit around the tricuspid valve annulus and through the cavo-tricuspid isthmus. Also, atrial flutter can be described as “clockwise” or “counterclockwise” depending on the direction of the circuit. type II) based on the anatomic location that it originates. Pathophysiology – Atrial FlutterĪtrial flutter can described as “typical” (a.k.a. Frequently, a 2:1 conduction ratio occurs, resulting in a ventricular rate of 150 bpm. The atrial rates during atrial flutter vary from 250 to 350 beats per minutes, slower than the 400 to 600 bpm seen in atrial fibrillation. This anatomically makes ablation much easier than in atrial fibrillation, which occurs in the pulmonary veins. Typical atrial flutter results from a reentrant circuit around the tricuspid valve and through the cavo-tricuspid isthmus. Atrial flutter is similar to atrial fibrillation in that the rhythm originates in the atrium and causes a narrow complex tachycardia, which carries thromboembolic risk.
0 kommentar(er)
