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Revision as of 00:57, 7 January 2013

Atrial flutter Microchapters

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Patient Information

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Epidemiology and Demographics

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Acute Treatment of Atrial Flutter
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Natural History

Atrial flutter is by nature unstable. It usually reverts back to either sinus rhythm or atrial fibrillation. Chronic atrial flutter state is very rare.

Complications

Although often regarded as a relatively benign rhythm problem, atrial flutter shares the same complications as the related condition atrial fibrillation. There is paucity of published data directly comparing the two, but overall mortality in these conditions appears to be very similar.

Rate Related

Rapid heart rates may produce significant symptoms in patients with pre-existing heart disease. Even in patients whose hearts are normal to start with, prolonged tachycardia tends to produce ventricular decompensation and heart failure.

Clot Formation

Because there is little if any effective contraction of the atria there is stasis (pooling) of blood in the atria. Stasis of blood in susceptible individuals can lead to formation of thrombus (blood clots) within the heart. Thrombus is most likely to form in the atrial appendages. Clot in the left atrial appendage is particularly important since the left side of the heart supplies blood to the entire body. Thus, any thrombus material that dislodges from the this side of the heart can embolize to the brain, with the potentially devastating consequence of a stroke. Thrombus material can of course embolize to any other portion of the body, though usually with a less severe outcome.

Sudden Cardiac Death

Sudden death is not directly associated with atrial flutter. However, in individuals with a pre-existing accessory conduction pathway, such as the bundle of Kent in Wolff-Parkinson-White syndrome, the accessory pathway may conduct activity from the atria to the ventricles at a rate that the AV node would usually block. Bypassing the AV node, the atrial rate of 300 beats/minute leads to a ventricular rate of 300 beats/minute (1:1 conduction). Even if the ventricles are able to sustain a cardiac output at such a high rates, 1:1 flutter with time may degenerate into ventricular fibrillation, causing hemodynamic collapse and death.

Prognosis

Prognosis of the patient depends on the underlying cause of flutter. After treating the acute episode of atrial flutter, sinus rhythm is usually restored and chronic therapy is not usually required. It is more difficult to control the heart rate in flutter compared to that in atrial fibrillation. It is very difficult to control rate in chronic flutter, as it is not responsive to anti-arrhythmic agents. The risk for thromboembolism in atrial flutter is nearly similar to that of atrial fibrillation.

References

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