Atrial Flutter
Let’s talk about atrial flutter.
Atrial flutter is an arrhythmia resulting from reentry in a macroreentrant circuit, most commonly in the right atrium. It is characterized by regular atrial activity with “sawtooth” appearance.
Criteria
- Atrial rate usually 300/min (usual range 250-350 bpm).
- “F” waves with “sawtooth” appearance, best seen in inferior leads and V1.
- Absence of baseline.
- PR interval unmeasurable.
Same rhythm strip with graphical explanation.
Note the negative fluter waves (F waves) with AV conduction ratio of 2:1 and ventricular rate of ~150 bpm.
Another example with clear F waves.
Atrial flutter with 2:1 conduction.
NOTE: Odd ratios (1:1, 3:1, 5:1) are really uncommon.
NOTE: Atrial flutter is probably the most overlooked arrhythmia.
NOTE: The most common AV ratio is 2:1, resulting in a ventricular rate of ~150 bpm.
NOTE: Atrial flutter can be typical or atypical depending on whether the cavotricuspid isthmus (CTI) participates or not in the reentrant circuit.
NOTE: Atrial flutter with 1:1 conduction and wide QRS is rare but often mistaken for ventricular tachycardia.
NOTE: Atrial flutter may presents with variable AV conduction, particularly after receiving cardiac medications.
Possible causes: The same as for atrial fibrillation.
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