| Atrial flutter | |
|---|---|
 | |
| Atrial flutter with varying A-V conduction (5:1 and 4:1) | |
| Specialty | Cardiology |
| Symptoms | None, palpitations, chest discomfort, lightheadedness[1][2] |
| Complications | Stroke, cardiomyopathy[2] |
| Usual onset | Sudden[3] |
| Types | Typical, atypical[2] |
| Causes | Unknown[4] |
| Risk factors | COPD, pulmonary hypertension, heart failure[2] |
| Diagnostic method | Electrocardiogram (ECG)[2] |
| Differential diagnosis | Sinus tachycardia, atrial fibrillation, multifocal atrial tachycardia[2][3] |
| Treatment | Electrical cardioversion, catheter ablation[2] |
| Medication | Diltiazem, metoprolol, blood thinners[2] |
| Frequency | 9 per 10,000 people per year[5] |
Atrial flutter (AFL) is an abnormal heart rhythm that starts in the upper chambers of the heart.[2] Generally, it is initially presents with a sudden onset of a fast heart rate.[2][3] Symptoms may be absent or include a feeling of the heart beating too fast or hard, chest discomfort, shortness of breath, or lightheadedness.[1][2] Complications can include stroke or cardiomyopathy.[2]
The cause is often unknown.[4] Risk factors include COPD, pulmonary hypertension, heart failure, and endurance sports.[2][4] Triggers can include electrolyte abnormalities, high thyroid, or low oxygen.[2] It is a type of supraventricular tachycardia.[3] Diagnosis is generally by an electrocardiogram (ECG) showing a flutter wave at 300 beats per minute with narrow QRS complexes every 2nd beat.[2][3] If the diagnosis is unclear, giving adenosine may help clarify the condition.[3] It may also convert into atrial fibrillation (AF).[4]
The recommended treatment is generally conversion to sinus rhythm.[2] If the person is unstable, this is generally done with electrical cardioversion.[2] If the person is otherwise stable medications, such as diltiazem, or electricity may be used.[2] Blood thinners may be recommended before cardioversion in stable cases to decrease the risk of stroke.[2][6] Atrial flutter is often treated more definitively with a technique known as catheter ablation.[1] Blood thinners may be stopped 6 weeks after ablation, if it is successful.[4]
Atrial flutter is the second most common supraventricular tachycardia, occurring less than one-tenth as often as atrial fibrillation.[3][5] It newly occurs in about 88 per 100,000 people per year; 5 per 100,000 in those under 50 and 587 per 100,000 in those over 80.[5] Males are affected more often than females.[2] Atrial flutter was identified as an independent condition around 1912 by the British physician Sir Thomas Lewis (1881–1945), though the ECG pattern was described a year early by Jolly and Ritchie.[7][8]
References edit
- ^ a b c Sawhney, NS; Anousheh, R; Chen, WC; Feld, GK (February 2009). "Diagnosis and management of typical atrial flutter". Cardiology Clinics (Review). 27 (1): 55–67, viii. doi:10.1016/j.ccl.2008.09.010. PMID 19111764.
- ^ a b c d e f g h i j k l m n o p q r s t Rodriguez Ziccardi, M; Goyal, A; Maani, CV (January 2020). "Atrial Flutter". PMID 31082029.
{{cite journal}}: Cite journal requires|journal=(help) - ^ a b c d e f g Link, MS (October 2012). "Clinical practice. Evaluation and initial treatment of supraventricular tachycardia". New England Journal of Medicine. 367 (15): 1438–48. doi:10.1056/NEJMcp1111259. PMID 23050527.
- ^ a b c d e Bennett, David H. (2012). Bennett's Cardiac Arrhythmias: Practical Notes on Interpretation and Treatment. John Wiley & Sons. p. 49. ISBN 978-1-118-43240-2.
- ^ a b c Bun, SS; Latcu, DG; Marchlinski, F; Saoudi, N (September 2015). "Atrial flutter: more than just one of a kind". European Heart Journal. 36 (35): 2356–63. doi:10.1093/eurheartj/ehv118. PMID 25838435.
- ^ Vadmann, H; Nielsen, PB; Hjortshøj, SP; Riahi, S; Rasmussen, LH; Lip, GY; Larsen, TB (September 2015). "Atrial flutter and thromboembolic risk: a systematic review". Heart. 101 (18): 1446–55. doi:10.1136/heartjnl-2015-307550. PMID 26149627.
- ^ Lewis T, Feil HS, Stroud WD (1920). "Observations upon flutter, fibrillation, II: the nature of auricular flutter". Heart. 7: 191.
- ^ Silverman, Mark E.; Fleming, Peter R.; Hollman, Arthur; Julian, Desmond G.; Krikler, Dennis M. (2012). British Cardiology in the 20th Century. Springer Science & Business Media. p. PT206. ISBN 978-1-4471-0773-6.