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Overview of atrial flutter

Authors
Robert Phang, MD, FACC, FHRS
Jordan M Prutkin, MD, MHS, FHRS
Leonard I Ganz, MD, FHRS, FACC
Section Editor
Peter J Zimetbaum, MD
Deputy Editor
Gordon M Saperia, MD, FACC

INTRODUCTION

Atrial flutter is an abnormal cardiac rhythm characterized by rapid, regular atrial depolarizations at a characteristic rate of approximately 300 beats/min and a regular ventricular rate of about 150 beats/min in patients not taking atrioventricular (AV) nodal blockers. It can lead to symptoms of palpitations, shortness of breath, fatigue, or lightheadedness, as well as an increased risk of atrial thrombus formation that may cause cerebral and/or systemic embolization.  

Atrial flutter occurs in many of the same situations as atrial fibrillation, which is much more common. Atrial flutter may be a stable rhythm or a bridge arrhythmia between sinus rhythm and atrial fibrillation. It may also be associated with a variety of other supraventricular arrhythmias. (See "Epidemiology of and risk factors for atrial fibrillation".)

This topic will summarize key points regarding the causes, clinical presentation, diagnosis, and management approach to patients with atrial flutter. Other topics discuss management issues in detail. (See "Restoration of sinus rhythm in atrial flutter" and "Control of ventricular rate in atrial flutter" and "Atrial flutter: Maintenance of sinus rhythm" and "Embolic risk and the role of anticoagulation in atrial flutter".)

ELECTROPHYSIOLOGIC CLASSIFICATION

Atrial flutter was previously classified as either type I or type II. That terminology is no longer used.  

Typical atrial flutter — The designation of "typical" atrial flutter involves a macroreentrant circuit traversing the cavo-tricuspid isthmus (CTI) (figure 1). This isthmus is the region of right atrial tissue between the orifice of the inferior vena cava and the tricuspid valve annulus (figure 2). If this isthmus is involved, it is called "typical" atrial flutter. In fact, typical atrial flutter is also called CTI-dependent atrial flutter. The circuit is usually a counterclockwise rotation around the tricuspid valve (figure 2), exhibiting a classic sawtooth appearance in the inferior electrocardiogram (ECG) leads (II, III, aVF) (image 1B). If the circuit is clockwise, it is called "reverse" or "clockwise" typical flutter, exhibiting positive flutter waves in the inferior ECG leads (image 1C).

                    

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Literature review current through: Jul 2017. | This topic last updated: May 05, 2017.
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