Atrial flutter resident survival guide
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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.
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]
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.