Atrial flutter is a cardiac arrhythmia characterized by atrial rates of 240 400 beats/min and some degree of atrioventricular av node conduction block. For the most part, morbidity and mortality are due to complications of rate eg, syncope and congestive heart failure chf . Fatigue or poor exercise tolerance atrial flutter is a cardiac arrhythmia characterized by atrial rates of 240 400 beats/min, usually with some degree of atrioventricular av node conduction block. In the most common form of atrial flutter type i atrial flutter , electrocardiography ecg demonstrates a negative sawtooth pattern in leads ii, i, and avf. Type i typical or classic atrial flutter involves a single reentrant circuit with circus activation in the right atrium around the tricuspid valve annulus. Type ii atypical atrial flutter follows a different circuit it may involve the right or the left atrium.

In most studies, approximately 60% of patients with atrial flutter have coronary artery disease cad or hypertensive heart disease 30% have no underlying cardiac disease. Uncommon forms of atrial flutter have been noted during long term follow up in as many as 26% of patients with surgical correction of congenital cardiac anomalies. Symptoms in patients with atrial flutter typically reflect decreased cardiac output as a result of the rapid ventricular rate. Transthoracic echocardiography tte is the preferred modality for evaluating atrial flutter. Intervening to control the ventricular response rate or to return the patient to sinus rhythm is important.

Consider immediate electrical cardioversion for patients who are hemodynamically unstable. Consider catheter based ablation as first line therapy in patients with type i typical atrial flutter if they are reasonable candidates. Ablation is usually done as an elective procedure however, it can also be done when the patient is in atrial flutter. Atrial flutter is similar to atrial fibrillation in many respects eg, underlying disease, predisposing factors, complications, and medical management , and some patients have both atrial flutter and atrial fibrillation. However, the underlying mechanism of atrial flutter makes this arrhythmia amenable to cure with percutaneous catheter based techniques. Blood enters the heart from the body into the right atrium and then travels into the right ventricle, which pumps blood to the lungs where it collects oxygen. Blood then returns back to the heart from the lungs into the left atrium, which then empties into the left ventricle.

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The heart contains an electrical system that coordinates the beating of the 4 chambers. The normal electrical activity of the heart begins in a small area of the right atrium called the sinus node figure 1 therefore, a normal heart rhythm is referred to as sinus rhythm. Electrical activity begins in the sinus node and then spreads to both atria, telling these chambers to contract.

The electrical activity then spreads to the ventricles, directing these chambers to contract and to pump blood out to the body. figure 1. a normal heartbeat begins in an area of the right atrium called the sinus node, the natural pacemaker of the heart. Electrical activation beginning in the sinus node directs the right and left atria to contract. The electrical stimulus then travels through the av node and to the ventricles, directing them to contract. The term arrhythmia can refer to a heart rhythm that is either too fast referred to as tachycardia or too slow bradycardia or to a heart rhythm that starts in some place other than the normal location for the electrical activity to begin. It is important to determine when the symptoms started, how often they occur, and how long each episode lasts.

If symptoms are intermittent also referred to as paroxysmal , a holter monitor a small pager sized device that attaches to small electrode stickers on the outside of the chest may be worn by the patient from anywhere between 24 hours and 30 days. Because the holter monitor records every heart beat over a 24 hour period, it can be used to diagnose atrial flutter and to determine how often it is occurring. Atrial flutter is more likely to occur in people who have some form of heart disease or medical condition such as congestive heart failure, rheumatic valve disease, congenital heart disease, lung disease such as emphysema, or high blood pressure. In addition, prior cardiac surgery may increase the risk of atrial flutter because of scarring of the atrium.

When atrial flutter occurs in people with a normal healthy heart, it is called lone atrial flutter. Atrial flutter also can occur in people who have other atrial arrhythmias such as atrial fibrillation a more irregular form of atrial rhythm abnormality. It can happen either spontaneously or when the atrial fibrillation is treated with antiarrhythmic medications. Signs and symptoms of atrial flutter may include palpitations, rapid heart rate, chest pain, shortness of breath, lightheadedness, fatigue, and low blood pressure. During atrial flutter, the atrium can beat up to 300 times a minute, and every second beat gets through to the ventricle, resulting in a pulse rate in the range of 150 beats per minute the normal heart beat is 60 to 90 beats per minute.