Atrial flutter is a quick and regular atrial rhythm due to a circular atrial macroreentrant excitement. Symptoms include palpitations and sometimes weakness, exercise intolerance, dyspnea, and syncope. Also, atrial thrombi can form and embolize. The diagnosis results from the ECG. The therapy comprises a drug control heart rate, thromboprophylaxis with anticoagulants and frequently a conversion to sinus rhythm by medication, cardioversion or ablation of atrial flutter.
Atrial flutter is much less common than VHF, but the causes and hemodynamic effects are similar. Many patients with atrial flutter also have episodes of AF.
Atrial flutter is a quick and regular atrial rhythm due to a circular atrial macroreentrant excitement. Symptoms include palpitations and sometimes weakness, exercise intolerance, dyspnea, and syncope. Also, atrial thrombi can form and embolize. The diagnosis results from the ECG. The therapy comprises a drug control heart rate, thromboprophylaxis with anticoagulants and frequently a conversion to sinus rhythm by medication, cardioversion or ablation of atrial flutter. Atrial flutter is much less common than VHF, but the causes and hemodynamic effects are similar. Many patients with atrial flutter also have episodes of AF. The classic atrial flutter occurs due to a large reentrant circuit, which includes most of the right atrium. The atria depolarize at a frequency of 250-350 beats / min (usually at 300 beats / min). However, the AV node can not conduct at such a high frequency. Therefore, only half of the pulses is characteristically transferred (2: 1 block), resulting in a regular ventricular rate of 150 beats / min. Sometimes the block varies constantly, resulting in an irregular ventricular rate. Less frequently, there is a stable 3: 1, 4: 1 or 5: 1 block. The probability of a thromboembolic event was once thought to be rather low. Today, however, it is assumed that the probability of this is about half the size (assuming there is not simultaneously a VHF ago) like a VHF. Clinical Calculator: HAS-BLED bleeding risk Scoree symptoms and complaints The symptoms depend primarily on the ventricular rate and the type of underlying cardiac dysfunction. At a regular ventricular rate of <120 beats / min probably only minor or no symptoms exist. Higher frequencies and variable AV cables produce palpitations usually. A reduced cardiac output can (. E.g., chest discomfort, dyspnea, weakness or syncope) produce symptoms of hemodynamic problems. A careful inspection of the Jugularvenenpulses can reveal (a-wave), the atrial flutter waves. Diagnostic ECG Diagnosis is from the ECG. In typical atrial flutter, the image of a continuous and regular atrial activity in the form of a sawtooth pattern which most clearly seen in leads II, III, and aVF (atrial flutter.) Results in the ECG. Atrial flutter. (Note:. Representation of a right bundle branch block) A massage of the carotid sinus may increase the AV-blockade and thus leads to a better representation of the typical flutter waves. A similar reaction can be shown (with adenosine z. B.) after a drug AV nodal block. Such therapy, however, does not terminate the atrial flutter. Drug treatment frequency control rhythm control by cardioversion, drugs or ablation thromboembolism The therapy focuses on the control of ventricular rate, the rhythm and the thromboembolism. Drug frequency control here, however difficult than the VHF. Therefore, the electrical conversion for most patients (with synchronized cardioversion or overdrive pacing), the treatment of choice for an initial episode and mandatory at a 1: 1 AV conduction or hemodynamic problems. As a rule, a conversion with low energy (50 joules) is effective. As with the VHF one Antikoagulazionvor cardioversion is necessary. At a drug restoring sinus rhythm frequency control must first be carried out by Nichtdihydropyridintyp with beta-blockers or Kalziumanatagonisten. Many of the antiarrhythmic drugs to restore the sinus rhythm (especially class Ia and Ic) can slow down the frequency of atrial flutter, shorten the refractory period of the AV node due to their vagolytic effect, or both, so it to a 1: 1 conduction with a paradoxical increase in ventricular and comes to a hemodynamic problem. These drugs are more suitable for long-term treatment to prevent a renewed atrial flutter. An anti-tachycardia pacing system is an alternative to long-term treatment with antiarrhythmic drugs in selected patients. The various ablation procedures for interrupting the atrial reentrant circuit can an atrial flutter, v. a. a typical atrial flutter, prevent effectively. In patients with chronic or recurrent atrial flutter is a long-term treatment with oral anticoagulants (warfarin, titrated to an INR of 2 and 3, direct thrombin inhibitors, or Factor Xa inhibitor) or aspirin required. The criteria for the selection of anticoagulant are the same as for VHF. Summary atrial flutter describes a fast, regular atrial rhythm, which can rarely cause an irregular or nichttachykarde QRS response, depending on the degree and type of the present block. After an initial rate control through medication wieAfter initial rate control with drugs: such as beta blockers calcium channel blockers from Nichtdihydropyrintyp (eg., Verapamil, diltiazem), synchronized cardioversion should be performed in most patients. Anticoagulation is necessary before cardioversion. Long-term oral anticoagulation for stroke prevention is required for patients with chronic or recurrent atrial flutter.