![]() A classification of atrial flutter and regular atrial tachycardia according to electrophysiological mechanisms and anatomical bases a statement from a joint expert group from the Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. ![]() 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia. This rhythm is closely related to atrial fibrillation. : Typical atrial flutter with variable (3 to 4:1) block From the collection of Dr K.C. ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter. ![]() Estes NA 3rd, Halperin JL, Calkins H, et al American College of Cardiology American Heart Association Task Force on Performance Measures Physician Consortium for Performance Improvement. Characteristic features on ECG are negatively directed saw-tooth atrial deflections (f waves) seen in leads II, III, and aVF, with positively directed deflections in lead V1. The term anticlockwise refers to the direction of activation when the tricuspid annulus is viewed en face, whereby activation occurs up the septum, down the right atrial free wall in an anticlockwise fashion. The typical form depends on the so-called cavotricuspid isthmus for part of the circuit: tricuspid annulus as the anterior boundary and the crista terminalis/eustachian ridge as the posterior boundary, as well as the endocardial cavity of the right atrium. It results from organised electrical activity in which large areas of the atrium take part in the re-entrant circuit. Typical atrial flutter (anticlockwise cavotricuspid isthmus-dependent atrial flutter) is a macro re-entrant atrial tachycardia with atrial rates usually above 250 bpm up to 320 bpm. If electrical cardioversion is unavailable or not acceptable to the patient, pharmacological cardioversion may be attempted. If the rhythm persists in a haemodynamically stable patient, despite rate control and treatment of the underlying cause (or in the absence of a reversible cause), electrical cardioversion is used to terminate the arrhythmia. If a patient is haemodynamically stable, the first-line treatment is rate control and management of the underlying cause. If a patient is haemodynamically unstable, they should be given emergency electrical cardioversion. Because of alterations in atrial activation, the ECG often fluctuates between both rhythms in the same patient. Atrial fibrillation may also convert to atrial flutter. This rhythm is commonly associated with atrial fibrillation, into which it may degenerate. Ventricular rates range from 120 to 160 bpm, and most characteristically 150 bpm, because an associated 2:1 atrioventricular block is common. By James Heilman, MD – Own work, CC BY-SA 4.Atrial flutter is typically characterised on the ECG by flutter waves, which are a saw-tooth pattern of atrial activation, most prominent in leads II, III, aVF, and V1.Ītrial rates are typically above 250 bpm and up to 320 bpm. The lead II shows inverted p waves and one of the p waves is hiding in the preceding T wave, resulting in 2:1 pattern. The following image is Atrial fluter but may not look like classic saw-tooth pattern. R waves can be regular on most of the occasions. Look for saw toothed appearance of P waves on the ECG (especially on Lead II). Due to this, the resultant QRS complexes are narrow complex waves. In the below image, you can see 5:1 and 4:1 ratio – Such ECGs can be irregular but most of the ECGs will have one ratio instead of 2 or 3 ratios in a single ECG.Īs in the case of AF, even here the potentials are originating above the ventricles. Depending on the ratio of passed potentials to ventricles, we might see a rate of 150 (if every alternate potential passes through) per minute or 100 per minute (if every 3rd potential passes through) 75 per minute (if every 4th potential passes through) Out of these 300 regular contractions (irregular in AF), some will pass through to ventricles via AV node. The atria beat at a rate of about 300 per minute. What can be the heart rate in atrial flutter?
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