Overview of atrial flutter
- Robert Phang, MD, FACC, FHRS
Robert Phang, MD, FACC, FHRS
- Albany Associates in Cardiology
- Jordan M Prutkin, MD, MHS, FHRS
Jordan M Prutkin, MD, MHS, FHRS
- Associate Professor of Medicine, Division of Cardiology, Electrophysiology Section
- University of Washington
- Leonard I Ganz, MD, FHRS, FACC
Leonard I Ganz, MD, FHRS, FACC
- Section Editor — Cardiac Arrhythmias
- Director of Cardiac Electrophysiology
- Heritage Valley Health System
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".)
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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- ELECTROPHYSIOLOGIC CLASSIFICATION
- Typical atrial flutter
- Atypical atrial flutter
- ETIOLOGY AND RISK FACTORS
- CLINICAL MANIFESTATIONS
- History and physical examination
- Additional testing
- DIFFERENTIAL DIAGNOSIS
- GENERAL TREATMENT ISSUES
- Rate control in atrial flutter
- Reversion to NSR
- Maintenance of NSR
- Prevention of systemic embolization
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS