Atrial flutter is a regular supraventricular tachycardia characterized by an atrial heart rate between 240/min and 340/min (typically 300/min), atrioventricular (AV) node conduction block, and a “sawtooth” pattern on an electrocardiogram (ECG). There are many cardiac and non-cardiac causes, but patients will usually have underlying structural heart disease. Symptoms include palpitations, shortness of breath, chest pain, dizziness, and nausea. Management is similar to atrial fibrillation, with a focus on rhythm control and preventing systemic embolization.
Last updated: Oct 14, 2022
Atrial flutter is caused by a macroreentrant electrical loop (reentrant circuit covers a large area of the atrium):
Typical atrial flutter:
Image shows the macroreentrant circuits in typical atrial flutter. Notice that the cavotricuspid isthmus is involved in typical atrial flutter.
Image by Lecturio.Atypical atrial flutter:
Complication | Possible symptoms | Exam findings | |
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Cardiac:
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Congestive heart failure Congestive heart failure Congestive heart failure refers to the inability of the heart to supply the body with normal cardiac output to meet metabolic needs. Echocardiography can confirm the diagnosis and give information about the ejection fraction. Congestive Heart Failure |
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Myocardial ischemia Ischemia A hypoperfusion of the blood through an organ or tissue caused by a pathologic constriction or obstruction of its blood vessels, or an absence of blood circulation. Ischemic Cell Damage |
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Thromboembolic:
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Stroke/ transient ischemic attack Transient ischemic attack Transient ischemic attack (TIA) is a temporary episode of neurologic dysfunction caused by ischemia without infarction that resolves completely when blood supply is restored. Transient ischemic attack is a neurologic emergency that warrants urgent medical attention. Transient Ischemic Attack (TIA) ( TIA TIA Transient ischemic attack (TIA) is a temporary episode of neurologic dysfunction caused by ischemia without infarction that resolves completely when blood supply is restored. Transient ischemic attack is a neurologic emergency that warrants urgent medical attention. Transient Ischemic Attack (TIA)) |
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Focal deficits on neurologic exam |
Splenic infarct Infarct Area of necrotic cells in an organ, arising mainly from hypoxia and ischemia Ischemic Cell Damage |
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Bowel infarct Infarct Area of necrotic cells in an organ, arising mainly from hypoxia and ischemia Ischemic Cell Damage |
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Renal infarct Infarct Area of necrotic cells in an organ, arising mainly from hypoxia and ischemia Ischemic Cell Damage |
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An ECG showing slow atrial flutter at an atrial cycle length of 400 ms (atrial rate of 150/min).
Image: “Atrial rate of 150/min” by Dept. of Cardiology, Beth Israel Medical Center. 16th Street and 1st Avenue. New York, New York 10003, USA. License: CC BY 2.5.An ECG showing a faster atrial flutter at an atrial cycle length of 280 ms (atrial rate of 214/min).
Image: “Atrial rate of 214/min” by Dept. of Cardiology, Beth Israel Medical Center. 16th Street and 1st Avenue. New York, New York 10003, USA. License: CC BY 2.5.An ECG showing the classic “sawtooth” appearance in atrial flutter.
Image by Lecturio.C | Congestive heart failure Congestive heart failure Congestive heart failure refers to the inability of the heart to supply the body with normal cardiac output to meet metabolic needs. Echocardiography can confirm the diagnosis and give information about the ejection fraction. Congestive Heart Failure | 1 |
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H | Hypertension Hypertension Hypertension, or high blood pressure, is a common disease that manifests as elevated systemic arterial pressures. Hypertension is most often asymptomatic and is found incidentally as part of a routine physical examination or during triage for an unrelated medical encounter. Hypertension | 1 |
A | Age (≥ 75 years) | 2 |
D | Diabetes mellitus Diabetes mellitus Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus | 1 |
S | Stroke, TIA TIA Transient ischemic attack (TIA) is a temporary episode of neurologic dysfunction caused by ischemia without infarction that resolves completely when blood supply is restored. Transient ischemic attack is a neurologic emergency that warrants urgent medical attention. Transient Ischemic Attack (TIA), or thromboembolism Thromboembolism Obstruction of a blood vessel (embolism) by a blood clot (thrombus) in the blood stream. Systemic Lupus Erythematosus | 2 |
V | Vascular disease | 1 |
A | Age 65–74 years | 1 |
Sc | Sex Sex The totality of characteristics of reproductive structure, functions, phenotype, and genotype, differentiating the male from the female organism. Gender Dysphoria category (female) | 1 |