II. Types

  1. Type I Atrial Flutter (typical)
    1. Constant atrial rate of 240 to 350 beats per minute
    2. Ventricular rate will usually be at least a 2:1 block (AV Node prevents rates above 180)
    3. Natural rate is altered by age, atrial dilation and Antiarrhythmics (esp Type Ia or Type Ic)
  2. Type II
    1. Constant atrial rate at 340 to 440 beats per minute (Faster Atrial Flutter rate than with Type I)
    2. Differs from Type I in reentry accessory path

III. Signs

  1. Constant atrial rate
    1. Atrial to ventricular rates may range from 1:1 to 4:1
    2. Atrial to ventricular rate 2 to 1 (most common)
      1. Atrial rate of 240 to 350 beats per minute
      2. Ventricular rate 140-150 beats per minute

IV. Diagnostics: EKG

  1. Constant atrial rate
    1. Atrial rate: 300 per minute (typical)
    2. Atrial to ventricular rate
      1. Ratio 1:1 - 300 bpm (Rare, but potentially lethal)
      2. Ratio 2:1 - 150 bpm (most common)
      3. Ratio 4:1 - 75 bpm
  2. Saw tooth flutter waves
    1. May be difficult to visualize at a 2:1 AV Block (rate 140-150) due to overlapping QRS Complex with flutter wave
    2. Increase EKG "paper speed" to 50 mm/sec (rapid) to spread out complexes (P Waves may be seen)
  3. Images
    1. cvEKGAtrialFlutter4to1sawtooth.jpg

V. Management

  1. See Atrial Fibrillation Management
  2. Highly responsive to Synchronized Cardioversion at low energy levels
    1. Dr. Amal Mattu (paraphrased): "you could rub your shoes together to shock Atrial Flutter back to sinus"

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Related Studies

Ontology: Atrial Flutter (C0004239)

Definition (NCI) A disorder characterized by an electrocardiographic finding of an organized, regular atrial rhythm with atrial rate of 240-340 beats per minute. Multiple P waves typically appear in the inferior leads in a saw tooth-like pattern between the QRS complexes. (CDISC)
Definition (NCI_CTCAE) A disorder characterized by a dysrhythmia with organized rhythmic atrial contractions with a rate of 200-300 beats per minute. The rhythm disturbance originates in the atria.
Definition (MSH) Rapid, irregular atrial contractions caused by a block of electrical impulse conduction in the right atrium and a reentrant wave front traveling up the inter-atrial septum and down the right atrial free wall or vice versa. Unlike ATRIAL FIBRILLATION which is caused by abnormal impulse generation, typical atrial flutter is caused by abnormal impulse conduction. As in atrial fibrillation, patients with atrial flutter cannot effectively pump blood into the lower chambers of the heart (HEART VENTRICLES).
Concepts Pathologic Function (T046)
MSH D001282
ICD9 427.32
SnomedCT 266306001, 155364009, 5370000
LNC LA17085-4
English Atrial Flutters, Auricular Flutter, Auricular Flutters, Flutter, Atrial, Flutter, Auricular, Flutters, Atrial, Flutters, Auricular, Atrial Flutter, atrial flutter (diagnosis), atrial flutter, Flutter atrial, Atrial Flutter [Disease/Finding], Flutter;atrial, flutter auricular, Flutter - atrial, ATRIAL FLUTTER, Atrial flutter, Atrial flutter (disorder), atrium; flutter, auricular; flutter
French FLUTTER AURICULAIRE, Flutter auriculaire, Flutter atrial
Portuguese FLUTTER AURICULAR, Flutter Auricular, Flutter auricular, Flutter Atrial
Dutch atriumflutter, atrium; flutter, auriculair; flutter, atriale flutter, Atriumfladderen, Boezemfladderen, Fladderen, boezem-
German Flattern Vorhof, Vorhofflattern, Aurikuläres Flattern
Swedish Förmaksfladder
Japanese シンボウソドウ, 心房粗動
Czech kmitání síní, Flutter síní, FLS, síňový flutter, flutter síní
Spanish Aleteo Auricular, Aleteo Atrial, Flúter auricular, Flutter atrial, Flutter Auricular, Flúter atrial, aleteo auricular (trastorno), aleteo auricular, flúter auricular, taquisistolia auricular, Aleteo auricular
Finnish Eteislepatus
Italian Flutter auricolare, Flutter atriale
Polish Trzepotanie przedsionków
Hungarian Pitvari fluttern, Atrialis flutter
Norwegian Atrieflutter