7/1/2023 0 Comments A flutter treatment![]() Polyuria is caused by the release of atrial natriuretic peptide in response to increased atrial pressures from contractions of atria against a closed AV valve. left ventricular dysfunction, respiratory insufficiency etc.). More severe symptoms (dyspnea, pre-syncope) may occur in patients with diminished reserve (e.g. The most frequent symptoms of atrial flutter are palpitations and/or mild chest dyscomfort. Atrial rhythm is typically around 300 / min (250-350/min.) Clinical picture Most typically, tachycardia rotates in the right atrium counter-clockwise around the tricuspid valve anulus (cavo-tricuspid isthmus – dependent flutter). the re-entry circuit occupies large areas of the atrium. PathophysiologyĪtrial flutter is a typical macro-reentrant tachycardia, i.e. “Lone” atrial flutter (without any recognisable underlying disease) is rare – only 2% of atrial flutter patients (2).Īn overview of ethiologic and precipitating factors, which may trigger atrial flutter is in table 1.In 38% of cases, atrial flutter is associated with chronic illness (heart failure, lung disease, hypertension).A first occurence of atrial flutter is in 60% of cases associated with a specific acute precipitating event (major surgery, pneumonia, myocardial infarction).EtiologyĪny supraventricular arrhythmia can be triggered by one ore more precipitating factors: excessive caffeine intake, alcohol (either from a single excess or regular drinking), nicotin, certain drugs, hyperthyreoidism, stress, menstruation, electrolyte disturbance, hypovolemia, fever, infection or lack of sleep. Case fatality is 1%, mostly related to underlying disease (1). Atrial flutter represents 0,1% of hospital discharges in the US, with the mean age at 67 years and male predominance cca 2:1. The overall incidence of atrial flutter is 0,09% (1), 58% of patients also have atrial fibrillation in their history. The patient stopped caffeine completely, resumed more regular sleeping habits and remained asymptomatic with low blood pressure and without any further therapy. Hypokalemia and hypertension were possibly caused by stress and caffeine. After re-discussing the ECG and the triggering moment, the arrhythmia was re-diagnosed as probable left atrial focal tachycardia, triggered by the ice passing esophagus during a "fragile period“ (stress + excess caffeine + lack of sleep). The patient slept for 6 hours and woke up in the early morning with a sinus rhythm. Treatment was extended with intravenous potassium, magnesium and metoprolol and with oral diazepam. The arrhythmia was not altered by propafenon, thus DC cardioversion was planned for the next morning. The initial treatment was enoxaparine subcutaneously and propafenon intravenously. The admission diagnosis was atrial flutter. Admission blood pressure was 160/110 mmHg, his potassium level was 3,4 mmol/l, his physical examination and echocardiogram normal. Within 30 minutes, an ECG was recorded (fig. The palpitations started precisely when the ice was passing through his oesophagus. The arrhythmia was triggered after having accidentaly swallowed an ice cube while drinking the last glass of Coke. He was exhausted after overnight work - he had not slept in the last 36 hours and had consumed 7 cups of coffee and 4 glasses of Coka-Cola during this period. The 53-year old normotensive male patient with no previous history of cardiac disease and a normal recent coronary CT scan was admitted for sudden onset of palpitations. Case descriptionĪs an introduction, I describe an example, of how atrial tachycardia (clearly triggered by external factors) was falsely diagnosed as flutter. However, only rarely do the doctors actually analyse the circumstances which have brought on the arrhythmia.Īvoiding these triggering circumstances might help in preventing future attacks.įurthermore, certain patients are referred for radiofrequency ablation (which is an effective treatment of "classical" atrial flutter), when in fact their true diagnosis is left atrial focal tachycardia - where radiofrequency ablation is substantially more difficult and provides only questionable long-term benefit. It is treated in daily practice mostly with DC cardioversion and subsequent antiarrhythmic drug use. Atrial flutter seems to be an easy electrocardiographic (ECG) diagnosis, which can be done by a medical student.
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