EMed

Atrial flutter

Background

  • Regular narrow arrhythmia ±AV block
  • Re-entrant circuit (usually Rt Atrium)
  • >half have IHD (⅓ no underlying pathology)

Clinical

Symptoms

  • Palpitations - rapid, regular, sudden on-offset
  • Rate related (↓output) pathology:

Signs

  • Regular tachycardia ~150/min
  • CCF (pulmonary/dependant oedema, JVP etc)
  • Underlying trigger (sepsis / murmurs / ↑T4)

Investigations

  • ECG (saw-tooth II,III,aVF)
  • Modified valsalva
  • ± adenosis (check with the EM senior)
Atrial Flutter Valsalva
A Flutter during valsalva

Management

Approach similar to AF.

  • Search for and treat any unerlying trigger
  • Control vent. rate (Β blockers [occasionally Ca++ channel blockers])
  • Consider anticoagulation (CHADS-Vasc vs HASBLED)
  • Cardioversion not as successful as in AF
  • If D/C discuss with cardiology re Electrophysiological studies

Content by Dr Íomhar O' Sullivan 26/05/2019. Last review Dr ÍOS 15/04/24.