Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 10-33: Atrial Flutter + Key Features Download Section PDF Listen +++ ++ Rapid, regular tachycardia presenting classically with 2 to 1 block in the AV node and ventricular heart rate of 150 beats/min; ECG shows "sawtooth" pattern of atrial activity (rate 300 beats/min) Stroke risk should be considered equivalent to that with atrial fibrillation Catheter ablation is highly successful and is considered the definitive treatment for typical atrial flutter Less common than atrial fibrillation May occur in patients with structurally normal hearts but is more commonly seen in patients with Chronic obstructive pulmonary disease (COPD) Valvular or structural heart disease Atrial septal defect Surgically repaired congenital heart disease + Clinical Findings Download Section PDF Listen +++ ++ Typical presenting symptoms include Palpitations Fatigue Mild dizziness Symptoms and signs of heart failure (dyspnea, exertional intolerance, edema) due to tachycardia-induced cardiomyopathy may be presenting complaints if arrhythmia is unrecognized for prolonged time + Diagnosis Download Section PDF Listen +++ ++ ECG typically demonstrates a "sawtooth" pattern of atrial activity in the inferior leads (II, III, and AVF) The reentrant circuit generates atrial rates of 250–350 beats/min, usually with transmission of every second, third, or fourth impulse through the AV node to the ventricles + Treatment Download Section PDF Listen +++ ++ Initially, digoxin, a beta-blocker, or a calcium channel blocker (Table 10–11) is used for rate control; conversion to sinus rhythm may result If not, ibutilide (1–2 mg) converts atrial flutter to sinus rhythm in ~50–70% of patients within 60–90 min Electrical cardioversion (25–50 J) is effective in ~90% of patients Precardioversion anticoagulation is not necessary for atrial flutter of < 48 h duration except in the setting of mitral valve disease Anticoagulation should be continued for at least 4 weeks after electrical or chemical cardioversion and longer in patients with risk factors for thromboembolism If atrial flutter is recurrent, consider radiofrequency catheter ablation of the reentrant circuit