Atrial flutter resident survival guide: Difference between revisions
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* Radiofrequency catheter ablation is superior to medical therapy. | * Radiofrequency catheter ablation is superior to medical therapy. | ||
===Anticoagulation for atrial flutter=== | ===Anticoagulation for atrial flutter=== | ||
* | * '''CHADS2 score''' | ||
** [[Congestive heart failure]] - 1 | |||
** [[Hypertension]] -1 | |||
** Age > 75 -1 | |||
** [[Diabetes Mellitus]] -1 | |||
** [[Stroke]] or [[TIA]] - 2 | |||
** Score > 2 anticoagulate | *** Score > 2 anticoagulate | ||
** Score < 2 [[Aspirin]] may be sufficient | *** Score < 2 [[Aspirin]] may be sufficient | ||
* | * '''CHA2DS2 VASc score''' | ||
** [[Congestive heart failure]] - 1 | |||
** [[Hypertension]] -1 | |||
** Age > 75 - 2 | |||
** [[Diabetes Mellitus]] -1 | |||
** [[Stroke]] or [[TIA]] - 2 | |||
** Vascular disease - 1 | |||
** Age - 65 -74 | |||
** Sex - Female | |||
** Score 0 low risk, no anticoagulation or aspirin 81-324 | *** Score 0 low risk, no anticoagulation or aspirin 81-324 | ||
** Score 1, moderate risk, oral anticoagulation or [[Aspirin]] | *** Score 1, moderate risk, oral anticoagulation or [[Aspirin]] | ||
** Score 2 or more, oral anticoagulation | *** Score 2 or more, oral anticoagulation | ||
==Don'ts== | ==Don'ts== | ||
Revision as of 21:39, 26 November 2013
| File:Critical Pathways.gif |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hilda Mahmoudi M.D., M.P.H.[2]
Definition
Atrial flutter is a reenterant arrhythmia with atrial rates between 250 and 340/min with regular ventricular response.
Causes
Life Threatening Causes
Life-threatening causes include conditions which result in death or permanent disability within 24 hours if left untreated.
Common Causes
- Acute coronary syndromes
- Cardiomyopathy
- Congenital heart disease
- Hypertensive heart disease
- Hyperthyroidism
- Mitral valve disease[1] [2]
Management
Shown below is an algorithm summarizing the approach to atrial flutter.[3]
| Atrial flutter | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Unstable | Stable | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| CHF, shock, acute MI | Rate control: AV-nodal blockers | Conversion DC cardioversion Atrial pacing Pharmacological conversion | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| DC cardioversion | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| If therapy for prevention of recurrences warranted | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Antiarrhythmic drugs | Catheter ablation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Management of atrial flutter depending on hemodynamic stability.
Attempts to electively revert atrial flutter to sinus rhythm should be preceded and followed by anticoagulant precautions, as
per AF.
AV indicates atrioventricular; DC, direct current.
Algorithm based on the 2003 ACC/AHA/ESC guidelines for the management of supraventricular arrhythmias.[3]
Do's
- It is often the result of pulmonary disease exacerbation, pericarditis, and open heart surgery
- Radiofrequency catheter ablation is superior to medical therapy.
Anticoagulation for atrial flutter
- CHADS2 score
- Congestive heart failure - 1
- Hypertension -1
- Age > 75 -1
- Diabetes Mellitus -1
- Stroke or TIA - 2
- Score > 2 anticoagulate
- Score < 2 Aspirin may be sufficient
- CHA2DS2 VASc score
- Congestive heart failure - 1
- Hypertension -1
- Age > 75 - 2
- Diabetes Mellitus -1
- Stroke or TIA - 2
- Vascular disease - 1
- Age - 65 -74
- Sex - Female
- Score 0 low risk, no anticoagulation or aspirin 81-324
- Score 1, moderate risk, oral anticoagulation or Aspirin
- Score 2 or more, oral anticoagulation
Don'ts
References
- ↑ Gutierrez SD, Earing MG, Singh AK, Tweddell JS, Bartz PJ (2012). "Atrial Tachyarrhythmias and the Cox-maze Procedure in Congenital Heart Disease". Congenit Heart Dis. doi:10.1111/chd.12031. PMID 23280242. Unknown parameter
|month=ignored (help) - ↑ Granada, J.; Uribe, W.; Chyou, PH.; Maassen, K.; Vierkant, R.; Smith, PN.; Hayes, J.; Eaker, E.; Vidaillet, H. (2000). "Incidence and predictors of atrial flutter in the general population". J Am Coll Cardiol. 36 (7): 2242–6. PMID 11127467. Unknown parameter
|month=ignored (help) - ↑ 3.0 3.1 "ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary". Retrieved 15 August 2013.