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For further information, see CMDT Part 10-33: Atrial Flutter
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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
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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
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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
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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