Restoration of sinus rhythm in atrial flutter
- Jordan M Prutkin, MD, MHS, FHRS
Jordan M Prutkin, MD, MHS, FHRS
- Associate Professor of Medicine, Division of Cardiology, Electrophysiology Section
- University of Washington
Atrial flutter is a supraventricular arrhythmia that can cause bothersome symptoms and promote atrial thrombus formation with the potential for systemic embolization. Restoration of sinus rhythm improves symptoms and decreases the risk of embolization if recurrence does not occur. (See "Overview of atrial flutter", section on 'Clinical manifestations' and "Embolic risk and the role of anticoagulation in atrial flutter", section on 'Embolic risk'.)
Issues related to the indications and therapeutic options for the restoration of sinus rhythm in atrial flutter will be reviewed here. Causes of atrial flutter, rate control therapy, the maintenance of sinus rhythm after cardioversion, and the role of anticoagulation in atrial flutter are discussed separately. (See "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 is a relatively common supraventricular arrhythmia that is characterized by rapid, regular atrial depolarizations at a characteristic rate of approximately 300 beats/min. (See "ECG tutorial: Atrial and atrioventricular nodal (supraventricular) arrhythmias", section on 'Atrial fibrillation and atrial flutter' and "Overview of atrial flutter".)
In the absence of rate slowing drugs or atrioventricular (AV) nodal disease, every other beat passes through the AV node and the ventricular rate is usually around 150 beats per minute. Because of the rapid rate, the patient may present with symptoms of palpitations, chest pain, dyspnea, fatigue, dizziness, and rarely hemodynamic shock, similar to patients with atrial fibrillation (AF) with a rapid ventricular response. (See "Hemodynamic consequences of atrial fibrillation and cardioversion to sinus rhythm", section on 'Adverse hemodynamics in AF'.)
In addition to improving symptoms, the restoration of sinus rhythm prevents the potential for the development of tachycardia-mediated cardiomyopathy and reduces the risk of systemic embolization. (See "Arrhythmia-induced cardiomyopathy", section on 'Atrial fibrillation and atrial flutter' and "Embolic risk and the role of anticoagulation in atrial flutter", section on 'Embolic risk'.)
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- METHOD OF CARDIOVERSION
- Electrical Cardioversion
- - Pharmacologic enhancement of direct current cardioversion
- Pharmacologic cardioversion
- Radiofrequency catheter ablation
- Atrial pacing
- MAINTENANCE OF SINUS RHYTHM
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS