Materiały źródłowe

• #1 Atrial flutter – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/atrial-flutter/symptoms-causes/syc-20352586

  Atrial flutter is a type of heart rhythm disorder. The heart’s upper chambers, called the atria, beat too quickly. […] Atrial flutter is a type of heart rhythm disorder, called an arrhythmia. It is similar to atrial fibrillation (AFib). But in atrial flutter the heart rhythm is more organized and less chaotic than in AFib. A person can have both atrial flutter and AFib. […] Treatment for atrial flutter may include medicines and a heart procedure. […] If you feel like your heart is pounding, fluttering, skipping a beat or beating too fast, make an appointment for a health checkup. You may be told to see a doctor trained in heart diseases, called a cardiologist. […] Changes in the heart’s electrical system cause atrial flutter. The heart’s electrical system controls the heartbeat. Some health conditions or heart surgery can change how electrical signals travel through the heart and cause atrial flutter.

• #1 Atrial flutter – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/183

  Atrial flutter, in the typical form, is characterized electrocardiographically by flutter waves, which are a saw-tooth pattern of atrial activation, most prominent in leads II, III, aVF, and V1. […] Atrial rates are typically above 250 bpm and up to 320 bpm. […] Ventricular rates range from 120 to 160 bpm, and most characteristically 150 bpm, because an associated 2:1 atrioventricular block is common. […] This rhythm is commonly associated with atrial fibrillation, into which it may degenerate. Atrial fibrillation may also convert to atrial flutter. […] If the rhythm persists despite treatment of the underlying cause or in the absence of a reversible cause, electrical cardioversion is used to terminate the arrhythmia. […] If electrical cardioversion is unavailable or not acceptable to the patient, pharmacologic cardioversion may be attempted.

• #1 Atrial Flutter ECG Review

  https://www.healio.com/cardiology/learn-the-heart/ecg-review/ecg-topic-reviews-and-criteria/atrial-flutter-review

  Atrial flutter occurs when a reentrant circuit is present, causing a repeated loop of electrical activity to depolarize the atrium at a rate of about 250 to 350 beats per minute; the atrial rate in atrial fibrillation is 400 to 600 bpm. […] This produces a characteristic sawtooth pattern of the P waves different from atrial fibrillation, in which the atrial rate is so fast that the P waves are not identifiable, or only coarse fibrillatory waves are seen. […] A narrow complex tachycardia at a ventricular rate of exactly 150 bpm is very commonly atrial flutter. […] The regularity of the QRS complexes frequently present with atrial flutter helps to distinguish it from atrial fibrillation, though atrial flutter with variable conduction of the P waves can also occur. […] When the heart rate is significantly elevated that is, greater than 150 bpm it is often difficult to determine atrial flutter from atrial fibrillation, atrial tachycardia or atrioventricular nodal reentrant tachycardia, or AVNRT.

• #1 Atrial Flutter Workup: Approach Considerations, Electrocardiography, Diagnostic Aids

  https://emedicine.medscape.com/article/151210-workup

  Obtain serum electrolyte and digoxin levels if appropriate. […] Consider obtaining blood gas measurements in patients with hypoxia or carbon monoxide intoxication. […] Chest radiography may be useful in the evaluation of lung disease and the pulmonary vasculature. […] In the common form of typical atrial flutter, the electrocardiogram (ECG) shows sawtooth flutter (F) waves. […] Flutter waves are often visualized best in leads II, III, aVF, or V1. […] The morphology of the flutter wave can predict findings in the electrophysiology laboratory. […] Vagal maneuvers can be helpful in determining the underlying atrial rhythm if flutter waves are not seen well. […] Adenosine, administered in an intravenous (IV) push followed with an IV bolus with flush, can also be helpful in making the diagnosis of atrial flutter by transiently blocking the atrioventricular node. […] Transthoracic echocardiography (TTE) is the preferred initial imaging modality for evaluating atrial flutter. […] TTE has low sensitivity for intra-atrial thrombi. […] Transesophageal echocardiography is the preferred technique for detecting thrombus in the left atrium.

• #1 Diagnosing Atrial Fibrillation & Atrial Flutter | NYU Langone Health

  https://nyulangone.org/conditions/atrial-fibrillation-atrial-flutter/diagnosis

  Advanced imaging, including MRI scan and CT scan, may be used to look for structural problems, scarring, or an injury in the heart that can lead to an arrhythmia. […] A surveillance monitor, including a Holter device, ambulatory telemetry device, or implantable cardiac loop recorder, may be recommended if you have intermittent and unpredictable episodes of arrhythmia. […] A Holter device is a small, wearable surveillance device that is the size of a smartphone. It records changes in heart rhythm over a 24- or 48-hour period. Your doctor uses the test results to determine whether there is evidence of a heart rhythm disorder. […] An ambulatory telemetry device is a lightweight, portable heart monitor that is worn for up to two weeks to measure your hearts electrical activity for signs of a heart rhythm disorder. Test results are sent wirelessly to your doctor for review via a secure website. […] An implantable cardiac loop recorder is a small device thats placed under the skin of the chest to continuously monitor and record your heart rhythm for up to two years. This device is used in the Reveal LINQ Heart Failure study to monitor people who are at increased risk of stroke.

• #1 Diagnosing Atrial Fibrillation & Atrial Flutter | NYU Langone Health

  https://nyulangone.org/conditions/atrial-fibrillation-atrial-flutter/diagnosis

  There are several imaging tests used to help in the treatment and management of AFib and atrial flutter. A transthoracic echocardiogram (TTE) is an ultrasound test that uses high-frequency sound waves to produce detailed images of the hearts size, shape, and motion as it pumps blood. This test can also reveal blood clots, which can lead to stroke, and evaluate the hearts ability to pump blood, called its ejection fraction. A low ejection fraction measurement may be a sign of heart failure. […] In a transesophageal echocardiogram (TEE), an ultrasound probe is inserted through the mouth and into the esophagus. Because the probe is placed close to the heart, a TEE can provide clearer pictures of the hearts chambers than a traditional echocardiogram. This test is used to rule out the presence of blood clots. TTE and TEE are often performed at the same time.

• #1 Atrial Flutter – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK540985/

  Electrocardiogram generally shows flutter waves with the absence of an isoelectric line between QRS complexes, with an atrial wave around 300 beats per minute with ventricular conduction that can be 2 to 1, 3 to 1 or 4 to 1 or with variable conduction due to Wenckebach phenomenon. […] Echocardiography for evaluating atrial flutter bases its value on determining underlying structural heart disease. […] An initial determination of atrial flutter triggers is necessary. […] Patients with atrial flutter have a similar risk of strokes as those with atrial fibrillation. […] The prognosis of patients with typical atrial flutter undergoing catheter ablation is good, with a recurrence rate of less than 5%. […] The most common complication of atrial flutter is the increased risk of embolic stroke and disability related to this event.

• #1 Atrial flutter – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/atrial-flutter/diagnosis-treatment/drc-20572204

  This portable ECG device is worn for up to 30 days or until an irregular heartbeat or symptoms occur. You typically press a button when symptoms occur. […] If irregular heartbeat symptoms don’t happen very often, this device may be placed under the skin in the chest area. The device constantly records the heart’s electrical activity. It can find irregular heart rhythms. […] This test uses sound waves to take pictures of the beating heart. It shows the structure of the heart and heart valves. It also shows how blood flows through the heart. […] These tests often involve walking on a treadmill or pedaling a stationary bike while the heart activity is checked. The tests show how the heart reacts to exercise. […] You may need this test to check for a blood clot in the lungs, which may cause atrial flutter. […] This test shows where incorrect heart signals start in the heart. A doctor moves one or more flexible tubes through a blood vessel, usually in the groin, to different areas in the heart. Sensors on the tips of the tubes record the heart’s electrical signals.

• #1 Atrial Flutter: Diagnosis and Management strategies | IntechOpen

  https://www.intechopen.com/chapters/59994

  The atrial rate in AFL is typically 240-320 bpm, but it might be slower if conduction is slow inside the circuit due to scars from prior ablation or surgery. […] Its very crucial to distinguish between isthmus-dependent and non-isthmus-dependent flutters in order to perform curative ablation. […] Entrainment is the essential maneuver to confirm the diagnosis. […] Typically, a 4-mm irrigated steerable ablation catheter is used in order to deliver point-by-point RF applications across CTI. […] Confirmation of bidirectional block is traditionally considered as the endpoint of AFL ablation.

• #1 Atrial flutter – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/atrial-flutter/diagnosis-treatment/drc-20572204

  To diagnose atrial flutter, a healthcare professional examines you and listens to your heart. A member of your care team takes your blood pressure. You usually are asked questions about your symptoms, health habits and medical history. […] You may have tests to check your heart and to look for health conditions that can cause an irregular heartbeat. Tests for atrial flutter may include: […] Blood and urine tests are done to look for health conditions or substances that may affect the heart or heartbeat. If your healthcare team thinks you have atrial flutter, you may have blood tests to check your liver, thyroid and kidneys. […] This quick test checks the electrical activity of the heart. It can show how fast or how slow the heart is beating. […] This portable ECG device can be worn for a day or more to record the heart’s activity during daily activities.

• #1 Atrial Flutter Workup: Approach Considerations, Electrocardiography, Diagnostic Aids

  https://emedicine.medscape.com/article/151210-workup

  Electrocardiography is essential in making the diagnosis and can provide essential information in distinguishing „typical” from „atypical” atrial flutter. […] Transthoracic echocardiography is the preferred initial imaging modality for evaluating atrial flutter. […] The history and physical examination findings guide laboratory studies. […] Although hyperthyroidism is a rare cause of atrial flutter, asymptomatic hyperthyroidism, especially in elderly patients, can manifest as atrial fibrillation or flutter and should be excluded with thyroid function studies. […] Obtain a complete blood cell count if anemia is suspected or the patient has a history of recent or current blood loss associated with the presenting symptoms. […] Serum electrolyte levels and pulmonary function tests may be indicated based on the history.

• #1 Atrial flutter differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Atrial_flutter_differential_diagnosis

  Atrial flutter should be differentiated from atrial fibrillation, multifocal atrial tachycardia, SVT and wide complex tachycardia. An electrocardiogram artifact from tremor also can be confused with atrial flutter. […] Atrial Flutter […] Regular or Irregular […] 75 (4:1 block), 100 (3:1 block) and 150 (2:1 block) beats per minute (bpm), but 150 is more common […] Sawtooth pattern of P waves at 250 to 350 bpm […] Less than 0.12 seconds, consistent, and normal in morphology […] Conduction may vary in response to drugs and maneuvers dropping the rate from 150 to 100 or to 75 bpm […] Incidence: 88 per 100,000 individuals.

• #1 Atrial Flutter • LITFL • ECG Library Diagnosis

  https://litfl.com/atrial-flutter-ecg-library/

  The most common AV ratio is 2:1, resulting in a ventricular rate of ~150 bpm. […] Higher-degree blocks can occur usually due to medications or underlying heart disease resulting in lower rates of ventricular conduction, e.g. 3:1 or 4:1 block. […] Atrial flutter with 1:1 conduction can occur due to sympathetic stimulation, or in the presence of an accessory pathway. […] The administration of AV-nodal blocking agents to a patient with Wolff-Parkinson-White syndrome can precipitate this. […] Atrial flutter with 1:1 conduction is associated with severe haemodynamic instability and progression to ventricular fibrillation. […] The term AV block in the context of atrial flutter is something of a misnomer. […] This is based on the anatomical location and direction of the re-entry circuit.

• #1 Atrial Flutter: Diagnosis and Management strategies | IntechOpen

  https://www.intechopen.com/chapters/59994

  The patients with flutter sometimes are asymptomatic or may present with a variety of symptoms including palpitations, dyspnea, fatigue, dizziness or reduced functional class. […] The clinical presentation will dictate acute therapeutic approach which may include cardioversion or rate control strategy. […] If AFL occurs in the context of an acute disease process, long-term rhythm control medication is usually not required once the AFL is converted and the underlying pathologic process is eliminated. […] However, typical AFL is very amenable to ablation but AV junction ablation and pacemaker implantation may be indicated if rhythm and rate control strategies including ablation have failed in atypical flutter. […] In typical counterclockwise AFL, the wave of depolarization propagates through the lateral right atrium, then travels through the CTI in a lateral-to-medial direction.

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• #1 Atrial Flutter: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22885-atrial-flutter

  A provider can tell which type of atrial flutter you have based on your electrocardiogram (EKG) results. […] A provider may use tests to diagnose atrial flutter, including: […] Electrocardiogram (ECG or EKG). This test creates a graph of your heart rhythm. If you have atrial flutter, the lines on the graph will look like a sawtooth or picket fence pattern. […] Echocardiogram. This can show blood clots in your atria and allow your provider to look at the condition of various parts of your heart. […] Blood tests. These can check for an overactive thyroid, electrolyte imbalance or other issues. […] Cardioversion works in 70% to 90% of people. Some people have less than a 5% chance of atrial flutter happening again after a catheter ablation. Others may have less successful procedures because of their type of atrial flutter. People with complex cases of atypical atrial flutter may have only a 70% success rate with ablation.

• #1 Atrial Flutter ECG, Causes, Symptoms, Treatment, Medication

  https://www.medicinenet.com/atrial_flutter/article.htm

  In stable patients, vagal maneuvers such as holding your breath and bearing down (like having a bowel movement) may be effective. Other procedures may need to be considered depending on the individual patient’s situation, for example, immediate electrical cardioversion is used for patients who have severe symptoms and are unstable. […] The procedures used for the treatment and management of atrial flutter are varied; however, the goals are similar – the restoration of sinus rhythm, control of ventricular rate prevention of recurrent episodes, and prevention of thrombus formation – all with minimizing adverse effects from therapy.

• #1 Atrial Flutter: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/151210-overview

  Atrial flutter is a cardiac arrhythmia characterized by atrial rates of 240-400 beats/min, usually with some degree of atrioventricular (AV) node conduction block. […] The following techniques aid in the diagnosis of atrial flutter: Electrocardiography: This is an essential diagnostic modality for atrial flutter […] Transthoracic echocardiography is the preferred initial imaging modality for evaluating atrial flutter. […] ECG is essential in making the diagnosis. Transthoracic echocardiography is the preferred initial imaging modality for evaluating atrial flutter.

• #1 Atrial Flutter | Conditions | UCSF Benioff Children’s Hospitals

  https://www.ucsfbenioffchildrens.org/conditions/atrial-flutter

  Atrial flutter may occur spontaneously with unpredictable timing. Therefore, in many cases, the condition requires specialized tests to acquire an accurate diagnosis. If your doctor suspects that your child has an arrhythmia, such as atrial flutter, he or she will order one or more of the following diagnostic tests to determine the source of your child’s symptoms. […] An electrocardiogram (ECG or EKG) records the heart’s electrical activity. Small patches called electrodes are placed on your child’s chest, arms and legs, and are connected by wires to the ECG machine. The electrical impulses of your child’s heart are translated into a graph or chart, enabling doctors to determine the pattern of electrical current flow in the heart and to diagnose arrhythmias. […] In an EP study, doctors insert special electrode catheters long, flexible wires into veins and guide them into the heart. These catheters sense electrical impulses and also may be used to stimulate different areas of the heart. Doctors can then locate the sites that are causing arrhythmias. The EP study allows doctors to examine an arrhythmia under controlled conditions and acquire more accurate, detailed information than with any other diagnostic test.

• #2 Atrial Flutter: Diagnosis and Management strategies | IntechOpen

  https://www.intechopen.com/chapters/59994

  Atrial flutter (AFL) is a regular, macro reentrant arrhythmia traditionally defined as a supraventricular tachycardia with an atrial rate of 240-320 beats per minute (bpm). […] Atrial flutter is classified to cavotricuspid isthmus (CTI) dependent (or typical) and non-isthmus dependent (atypical). […] In this chapter, clinical aspects of atrial flutter will be discussed in detail which includes classification, clinical manifestation, ECG and electrophysiological characteristics and medical or invasive management. […] The incidence of AFL in the United States is 88 per 100,000 person-years. […] The most practical classification is based on isthmus versus non-isthmus dependency. […] Atypical flutter, or non-CTI-dependent macroreentrant atrial tachycardia, is attributed to those flutters that do not use the CTI originating in the right (RA) or left atrium (LA).

• #2 Atrial flutter – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000224

  Atrial flutter is typically characterised on the ECG by flutter waves, which are a saw-tooth pattern of atrial activation, most prominent in leads II, III, aVF, and V1. […] Atrial rates are typically above 250 bpm and up to 320 bpm. […] Ventricular rates range from 120 to 160 bpm, and most characteristically 150 bpm, because an associated 2:1 atrioventricular block is common. […] If a patient is haemodynamically unstable, they should be given emergency electrical cardioversion. […] If a patient is haemodynamically stable, the first-line treatment is rate control and management of the underlying cause. […] If the rhythm persists in a haemodynamically stable patient, despite rate control and treatment of the underlying cause (or in the absence of a reversible cause), electrical cardioversion is used to terminate the arrhythmia.

• #2 Atrial Flutter • LITFL • ECG Library Diagnosis

  https://litfl.com/atrial-flutter-ecg-library/

  Narrow complex tachycardia. […] Regular atrial activity at ~300 bpm. […] Loss of the isoelectric baseline. […] Saw-tooth pattern of inverted flutter waves in leads II, III, aVF. […] Upright flutter waves in V1 that may resemble P waves. […] Ventricular rate depends on AV conduction ratio. […] The ventricular response is irregular and may mimic atrial fibrillation (AF). […] On closer inspection, there may be a pattern of alternating 2:1, 3:1 and 4:1 conduction ratios. […] Atrial flutter is a form of supraventricular tachycardia caused by a re-entry circuit within the right atrium. […] The length of the re-entry circuit corresponds to the size of the right atrium, resulting in a fairly predictable atrial rate of around 300 bpm (range 200-400). […] Ventricular rate is determined by the AV conduction ratio (degree of AV block).

• #2 Search

  https://acadoodle.com/articles/19

  This brings us on to our next point. […] During complete transient block of conduction through the AV node induced by intravenous adenosine, flutter waves may become obvious clinching a diagnosis of atrial flutter. […] Atrial depolarisation is occurring at a rate of 300 times per minute on this ECG. This is atrial flutter with 2 to 1 conduction. […] The ECG shown here screams 'flutter’. […] The sawtooth pattern should be sought in all leads, in some instances the sawtooth pattern is more obvious in the chest or anterior leads. […] The fact that the broad complex tachycardia above was recorded in a conscious patient makes VT less likely (though far from impossible). […] The 'one fifty rule’ refers to the diagnosis of atrial flutter. it has nothing to do with sinus tachycardia.

• #2 Atrial flutter: RF, differential diagnosis, management strategies

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-6/Atrial-flutter-RF-differential-diagnosis-management-strategies-Title-Atria

  ECGs should always be read by an experienced physician and automated analysis systems of 12-lead ECG are unreliable – they commonly suggest incorrect arrhythmia diagnosis. […] Transesophageal ECG recordings of the atrial activity may be useful to distinguish flutter from other arrhythmias. […] A surface 12-lead electrocardiogram (ECG) is frequently sufficient for diagnosis, but it may be difficult to differentiate atrial flutter from focal atrial tachycardias or other supraventricular tachycardias, which have different mechanisms and treatment. […] Atrial flutter usually has the atrial rate at almost precisely 300 / min. and ventricular rate most oftentimes at 150 / min. (2:1 A-V block). […] Vagal stimulation, adenosine or betablockers may increase the degree of A-V block and classical „flutter waves” can be visualised on the ECG as positive atrial waves in V1 and negative „sawtooth” pattern atrial waves in III, aVF (fig. 2).

• #2 Atrial Flutter: Types, Symptoms, Causes, Tests, and Treatments

  https://www.webmd.com/heart-disease/atrial-fibrillation/atrial-flutter

  Event monitor (sometimes called a cardiac event monitor). If your heart rhythm needs to be tracked for longer than 48 hours, this is what you’ll need. Like a Holter monitor, it’s a type of portable EKG. But it doesn’t record continuously. Instead, it switches on when it detects an arrhythmia or when you manually activate it when you experience symptoms. These monitors can be worn for up to a month. Other types of monitors are available to track your heart rhythm over longer periods. […] Echocardiogram. This painless and noninvasive test uses sound waves to create a picture of your heart at work. This will reveal any abnormalities, such as damaged heart valves or enlarged chambers, that affect how the heart pumps blood. It also can detect blood clots that can form due to atrial flutter. If your doctor needs a fuller view of your heart, you will be sedated before undergoing an echo test in which a probe gets inserted down your throat until it’s near your heart. Once there, it produces ultrasound images of your heart. It’s used to confirm that blood clots have not formed in your heart.

• #2 Atrial Flutter Workup: Approach Considerations, Electrocardiography, Diagnostic Aids

  https://emedicine.medscape.com/article/151210-workup

  Obtain serum electrolyte and digoxin levels if appropriate. […] Consider obtaining blood gas measurements in patients with hypoxia or carbon monoxide intoxication. […] Chest radiography may be useful in the evaluation of lung disease and the pulmonary vasculature. […] In the common form of typical atrial flutter, the electrocardiogram (ECG) shows sawtooth flutter (F) waves. […] Flutter waves are often visualized best in leads II, III, aVF, or V1. […] The morphology of the flutter wave can predict findings in the electrophysiology laboratory. […] Vagal maneuvers can be helpful in determining the underlying atrial rhythm if flutter waves are not seen well. […] Adenosine, administered in an intravenous (IV) push followed with an IV bolus with flush, can also be helpful in making the diagnosis of atrial flutter by transiently blocking the atrioventricular node. […] Transthoracic echocardiography (TTE) is the preferred initial imaging modality for evaluating atrial flutter. […] TTE has low sensitivity for intra-atrial thrombi. […] Transesophageal echocardiography is the preferred technique for detecting thrombus in the left atrium.

• #2 Atrial Flutter: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/heart/arrhythmias/atrial-flutter/treatment

  Event monitor – Another type of portable EKG device, an event monitor, records the heart rhythm only when you activate it. You can turn it on when you are having symptoms. You might wear an event monitor for up to a month. […] Electrophysiological (EP) study – This test checks for abnormal heart rhythms and helps determine where the problem is. During an EP study, thin wire electrodes are threaded through a vein and into the heart, where they detect and record its electrical activity. This procedure requires sedation. […] Consumer products Products and devices such as a smartwatch or certain apps can help you screen for arrhythmias.

• #2 Atrial Flutter, Typical and Atypical: A Review | AER Journal

  https://www.aerjournal.com/articles/atrial-flutter-typical-and-atypical-review?language_content_entity=en

  Radiofrequency catheter ablation of the CTI has become a standard treatment for typical flutter. […] The recurrence rate of typical flutter is 10 % after successful CTI ablation and definitive flutter suppression can be attained by a second procedure in recurrent cases. […] The main problem is the incidence of AF after ablation, which can be 30-50 % in the long term (3 years). […] Atypical flutter is often associated with structural heart disease, especially in patients that have undergone cardiac surgery or extensive catheter ablation for the treatment of AF. […] Management of atypical flutter does not differ from that of typical flutter, but the more frequent association with structural heart disease and the multiple possible mechanisms causing an atypical ECG pattern are important factors to consider before making therapeutic decisions.

• #2 Atrial flutter – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/183

  Because of alterations in atrial activation, the ECG often fluctuates between both rhythms in the same patient. […] Key diagnostic factors include worsening heart failure or pulmonary symptoms and jugular venous pulsations with rapid flutter waves. […] Other diagnostic factors include palpitations, fatigue or lightheadedness, chest pain, dyspnea, syncope, hypotension, and embolic events. […] 1st tests to order include ECG, thyroid function tests, and serum electrolytes. […] Investigations to avoid include imaging stress tests and coronary CT angiography. […] Tests to consider include pulmonary function tests, CXR, digitalis level, cardiac enzymes, spiral CT with pulmonary embolism protocol, transthoracic echocardiogram, atrial electrogram recording, and electrophysiologic studies.

• #2 Atrial Flutter | Conditions | UCSF Benioff Children’s Hospitals

  https://www.ucsfbenioffchildrens.org/conditions/atrial-flutter

  Atrial flutter may occur spontaneously with unpredictable timing. Therefore, in many cases, the condition requires specialized tests to acquire an accurate diagnosis. If your doctor suspects that your child has an arrhythmia, such as atrial flutter, he or she will order one or more of the following diagnostic tests to determine the source of your child’s symptoms. […] An electrocardiogram (ECG or EKG) records the heart’s electrical activity. Small patches called electrodes are placed on your child’s chest, arms and legs, and are connected by wires to the ECG machine. The electrical impulses of your child’s heart are translated into a graph or chart, enabling doctors to determine the pattern of electrical current flow in the heart and to diagnose arrhythmias. […] In an EP study, doctors insert special electrode catheters long, flexible wires into veins and guide them into the heart. These catheters sense electrical impulses and also may be used to stimulate different areas of the heart. Doctors can then locate the sites that are causing arrhythmias. The EP study allows doctors to examine an arrhythmia under controlled conditions and acquire more accurate, detailed information than with any other diagnostic test.

• #2 Atrial Flutter Workup: Approach Considerations, Electrocardiography, Diagnostic Aids

  https://emedicine.medscape.com/article/151210-workup

  Electrocardiography is essential in making the diagnosis and can provide essential information in distinguishing „typical” from „atypical” atrial flutter. […] Transthoracic echocardiography is the preferred initial imaging modality for evaluating atrial flutter. […] The history and physical examination findings guide laboratory studies. […] Although hyperthyroidism is a rare cause of atrial flutter, asymptomatic hyperthyroidism, especially in elderly patients, can manifest as atrial fibrillation or flutter and should be excluded with thyroid function studies. […] Obtain a complete blood cell count if anemia is suspected or the patient has a history of recent or current blood loss associated with the presenting symptoms. […] Serum electrolyte levels and pulmonary function tests may be indicated based on the history.

• #2 Atrial Fibrillation: Nursing Diagnosis & Interventions | Nurse.com

  https://www.nurse.com/clinical-guides/atrial-flutter-and-atrial-fibrillation/?srsltid=AfmBOooSMwy7LCroRgATumpsliF_gRz7uNmlNXia_ovh8o3mGFeSFTqj

  Diagnosis for atrial fibrillation begins with a thorough history and physical followed by an electrocardiogram (ECG) (Nesheiwat et al., 2023). Criteria found on ECG to diagnose atrial fibrillation includes: […] To diagnose atrial flutter, a history and physical should be done to include prior episodes of atrial fibrillation (Rodriguez Ziccardi et al., 2021). ECG criteria for atrial flutter includes: […] A transesophageal echocardiogram (TEE) should be done to visualize if there is an atrial thrombus. Pulmonary function testing is necessary for individuals with atrial flutter because there is a strong correlation between lung disease and atrial arrhythmias. […] Electrophysiology studies with mapping will confirm the flutter mechanism and guide catheter ablation treatment.

• #2 Atrial Flutter Topic Review

  https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/atrial-flutter

  Diagnosing atrial flutter is done predominantly on the surface ECG. Sinus P waves are absent. The classic sawtooth pattern occurs, as the reentrant circuit around the tricuspid valve is large, resulting in high-amplitude P waves. […] The ventricular rate is frequently elevated and regular the latter of which is an important factor that allows for differentiation between atrial flutter and atrial fibrillation. However, if variable conduction of the atrial flutter waves to the ventricles is present, the QRS complexes can be irregularly irregular. […] When the heart rate is significantly elevated that is, greater than 150 bpm it is frequently difficult to differentiate atrial flutter from atrial fibrillation, atrial tachycardia or atrioventricular nodal reentrant tachycardia, or AVNRT. In this situation, giving adenosine will transiently slow the ventricular rate, unmasking the atrial flutter waves and allowing a more definitive diagnosis to be made.

• #2 Atrial Flutter ECG Review

  https://www.healio.com/cardiology/learn-the-heart/ecg-review/ecg-topic-reviews-and-criteria/atrial-flutter-review

  Atrial flutter can described as typical (type I) or atypical (type II) based on the anatomic location from which it originates. […] Typical atrial flutter rotates counterclockwise in direction, from a reentrant circuit around the tricuspid valve annulus and through the cavo-tricuspid isthmus. […] Atypical atrial flutter originates from the left atrium or areas in the right atrium, such as surgical scars, and has a variable appearance on ECG in regards to the flutter waves.

• #2 Atrial Flutter • LITFL • ECG Library Diagnosis

  https://litfl.com/atrial-flutter-ecg-library/

  Sometimes known as type I flutter, this involves the IVC tricuspid isthmus in the reentry circuit. […] The majority of left atrial conduction and activation thus occurs in a retrograde manner, forming negative flutter waves in inferior leads. […] In both forms of typical atrial flutter, the reentrant circuit is formed in the right atrium. […] The block varies between 2:1 and 4:1. […] The presence of positive flutter waves in lead II suggests a clockwise re-entry circuit. […] The diagnosis of flutter with variable block could be inferred here from the R-R intervals alone. […] Flutter waves are often very difficult to see when 2:1 block is present. […] Suspect atrial flutter with 2:1 block whenever there is a regular narrow-complex tachycardia at 150 bpm particularly when the rate is extremely consistent.

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• #2 Atrial Flutter | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/17963

  Atrial flutter is the second most common cardiac arrhythmia after atrial fibrillation. […] Atrial flutter is more frequent in males than in females. Aging is a significant risk factor as other associated disorders in patients with atrial fibrillation include systemic hypertension, diabetes mellitus, and a history of alcohol abuse. […] Electrocardiogram generally shows flutter waves with the absence of an isoelectric line between QRS complexes, with an atrial wave around 300 beats per minute with ventricular conduction that can be 2 to 1, 3 to 1 or 4 to 1 or with variable conduction due to Wenckebach phenomenon. […] Echocardiography for evaluating atrial flutter bases its value on determining underlying structural heart disease. […] Treatment management should focus on the following aspects: Rhythm control, Rate control, Anticoagulation due to embolization risk.

• #2 Atrial Flutter: Causes, Symptoms, Complications, Diagnosis, and Treatment | Everyday Health

  https://www.everydayhealth.com/atrial-fibrillation/guide/atrial-flutter/

  Atrial flutter is diagnosed based on your medical and family history, a physical exam, and an EKG, according to the Merck Manual. […] If an EKG shows that you have atrial flutter (shown by the sawtooth pattern), your doctor may also conduct an ultrasound of your heart (echocardiogram) to evaluate your heart and spot any blood clots. […] Treatment of atrial flutter focuses on slowing the heart rate, reducing the risk of stroke, and converting the flutter to a normal rhythm driven by the sinus node. […] Several classes of medication can help slow your heart rate, including beta blockers, calcium channel blockers, and digoxin. […] A procedure called electrical cardioversion in which you’re given a brief, low-power electrical shock through your chest while under anesthesia is often used to restore a normal sinus heart rhythm. […] Antiarrhythmic medication, such as sodium-channel or potassium-channel blockers, may help restore a normal rhythm or maintain normal rhythm after electrical cardioversion. […] Alternatively, your doctor may advise radio frequency ablation to convert an atrial flutter to normal sinus rhythm.

• #2 Atrial Flutter Diagnosis & Treatments Marbella

  https://www.cardiocaremarbella.com/atrial-flutter

  Atrial flutter is a common abnormal heart rhythm where the upper chambers (atria) of the heart are beating too fast. […] In atrial flutter, the AV node will receive more signals than usual from the atria and in most cases will allow (filter) a certain number through, often seen in a ratio of 1 in 2, 1 in 3 or 1 in 4 patterns. […] If the Cardiologist suspects atrial flutter, then a simple ECG may already confirm the diagnosis. […] An echocardiography, referred to as an 'echo’, is performed to evaluate the structure and function of the heart in some detail, which may reveal a structural cause of the atrial fibrillation, like heart chamber dilatation or valvular disease. […] One of the most important aspects of your assessment will be to evaluate your individual risk for a stroke to determine whether you will benefit from blood thinning medication (anticoagulants).

• #2 Atrial Flutter, Typical and Atypical: A Review | AER Journal

  https://www.aerjournal.com/articles/atrial-flutter-typical-and-atypical-review?language_content_entity=en

  In doubtful cases it is essential to document atrial activity dissociated from ventricular activity by increasing AV block by vagal manoeuvres or intravenous adenosine. […] The thickness of the terminal crest and its capacity to block transverse conduction are increased in cases of flutter compared to AF. […] Clinical presentation will depend in large part on the ventricular rate, which is most often around 120-150 due to 2:1 AV conduction, but in some cases 1:1 AV conduction leads to extremely high rates with poor clinical tolerance often requiring immediate intervention. […] Rate control should be the first treatment step in symptomatic patients with a rapid ventricular rate. […] Dofetilide and ibutilide, pure class III AADs, are effective for interrupting flutter with a small risk of QT prolongation and torsade de pointes.

• #2 Atrial flutter: Overview of diagnosis and management – UpToDate

  https://www.uptodate.com/contents/atrial-flutter-overview-of-diagnosis-and-management

  Atrial flutter is a cardiac arrhythmia characterized by rapid, regular atrial depolarizations at a characteristic rate of approximately 300 beats/min and a typically regular ventricular rate of approximately 150 beats/min (image 1). […] This topic will discuss the epidemiology, clinical presentation, diagnosis, and management of atrial flutter. […] DIAGNOSIS […] Electrocardiogram […] Atrial flutter waves […] Ventricular rate […] Concurrent conditions […] Ambulatory ECG monitoring […] DIAGNOSTIC EVALUATION […] Echocardiogram […] Additional testing.

• #3 Atrial flutter: classification, causes, ECG criteria and management – The Cardiovascular

  https://ecgwaves.com/topic/atrial-flutter-ecg-treatment-management/

  Atrial flutter is the second most common pathological tachyarrhythmia. Atrial flutter causes characteristic ECG changes, as discussed below. Atrial flutter tends to accompany atrial fibrillation, although some individuals may only present with atrial flutter. The ECG shows regular flutter waves (F-waves; not to be confused with f-waves seen in atrial fibrillation) which gives the baseline a saw-tooth appearance. Atrial flutter is the only diagnosis causing this baseline appearance, which is why it must be recognized on the ECG. The atrial rate (i.e the rate measured between flutter waves) typically ranges between 250 and 350 beats per minute (which is slower than the atrial rate in atrial fibrillation). One should always consider atrial flutter when confronted with a regular tachyarrhythmia at 150 beats per minute. Atypical atrial flutter is a consequence of cardiac surgery or extensive ablation therapy. However, flutter waves can still be seen and a history of ablation therapy or cardiac surgery will be sufficient for diagnosing an atypical atrial flutter. The probability of spontaneous conversion to sinus rhythm is low, as compared with atrial fibrillation. Moreover, pharmacological cardioversion is not particularly effective. Electrical cardioversion is the choice of therapy. Ablation therapy is a highly effective treatment that may cure the majority of patients referred to the intervention.

• #3 Atrial Flutter, Typical and Atypical: A Review | AER Journal

  https://www.aerjournal.com/articles/atrial-flutter-typical-and-atypical-review?language_content_entity=en

  In doubtful cases it is essential to document atrial activity dissociated from ventricular activity by increasing AV block by vagal manoeuvres or intravenous adenosine. […] The thickness of the terminal crest and its capacity to block transverse conduction are increased in cases of flutter compared to AF. […] Clinical presentation will depend in large part on the ventricular rate, which is most often around 120-150 due to 2:1 AV conduction, but in some cases 1:1 AV conduction leads to extremely high rates with poor clinical tolerance often requiring immediate intervention. […] Rate control should be the first treatment step in symptomatic patients with a rapid ventricular rate. […] Dofetilide and ibutilide, pure class III AADs, are effective for interrupting flutter with a small risk of QT prolongation and torsade de pointes.

• #3 Atrial Flutter: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/heart/arrhythmias/atrial-flutter/treatment

  Event monitor – Another type of portable EKG device, an event monitor, records the heart rhythm only when you activate it. You can turn it on when you are having symptoms. You might wear an event monitor for up to a month. […] Electrophysiological (EP) study – This test checks for abnormal heart rhythms and helps determine where the problem is. During an EP study, thin wire electrodes are threaded through a vein and into the heart, where they detect and record its electrical activity. This procedure requires sedation. […] Consumer products Products and devices such as a smartwatch or certain apps can help you screen for arrhythmias.

• #3 Atrial Flutter: Types, Symptoms, Causes, Tests, and Treatments

  https://www.webmd.com/heart-disease/atrial-fibrillation/atrial-flutter

  Event monitor (sometimes called a cardiac event monitor). If your heart rhythm needs to be tracked for longer than 48 hours, this is what you’ll need. Like a Holter monitor, it’s a type of portable EKG. But it doesn’t record continuously. Instead, it switches on when it detects an arrhythmia or when you manually activate it when you experience symptoms. These monitors can be worn for up to a month. Other types of monitors are available to track your heart rhythm over longer periods. […] Echocardiogram. This painless and noninvasive test uses sound waves to create a picture of your heart at work. This will reveal any abnormalities, such as damaged heart valves or enlarged chambers, that affect how the heart pumps blood. It also can detect blood clots that can form due to atrial flutter. If your doctor needs a fuller view of your heart, you will be sedated before undergoing an echo test in which a probe gets inserted down your throat until it’s near your heart. Once there, it produces ultrasound images of your heart. It’s used to confirm that blood clots have not formed in your heart.

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• #3 Atrial flutter – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/atrial-flutter/diagnosis-treatment/drc-20572204

  This portable ECG device is worn for up to 30 days or until an irregular heartbeat or symptoms occur. You typically press a button when symptoms occur. […] If irregular heartbeat symptoms don’t happen very often, this device may be placed under the skin in the chest area. The device constantly records the heart’s electrical activity. It can find irregular heart rhythms. […] This test uses sound waves to take pictures of the beating heart. It shows the structure of the heart and heart valves. It also shows how blood flows through the heart. […] These tests often involve walking on a treadmill or pedaling a stationary bike while the heart activity is checked. The tests show how the heart reacts to exercise. […] You may need this test to check for a blood clot in the lungs, which may cause atrial flutter. […] This test shows where incorrect heart signals start in the heart. A doctor moves one or more flexible tubes through a blood vessel, usually in the groin, to different areas in the heart. Sensors on the tips of the tubes record the heart’s electrical signals.

• #3 Atrial Flutter – What You Need to Know

  https://www.drugs.com/cg/atrial-flutter.html

  How is atrial flutter diagnosed? […] Your healthcare provider will ask about your symptoms and if they come and go. He or she will measure your heart rate. Tell him or her what health conditions you have and what medicines you take. He or she will also ask if you smoke, drink alcohol, or use any illegal drugs. You may need any of the following tests: […] An EKG records your heart rate and rhythm. You may also need to wear a Holter monitor while you do your normal activities. The Holter monitor is a portable EKG. […] Blood and urine tests check for infection, thyroid function, and potassium and calcium levels. […] A chest x-ray checks for infection or others problems in your heart and lungs. […] An echocardiogram is a type of ultrasound. Sound waves are used to show the structure and function of your heart.

• #3 Atrial Flutter: Types, Symptoms, Causes, Tests, and Treatments

  https://www.webmd.com/heart-disease/atrial-fibrillation/atrial-flutter

  EP study. Short for electrophysiology study, this is an invasive test used to identify the cause of your atrial flutter. Your doctor will insert long, thin tubes called catheters into a blood vessel and move them to your heart. These catheters are tipped with sensors that can measure and record your heart’s electrical activity in great detail. The sensors also can send electrical signals that will speed up or slow down your heart, allowing your doctor to pinpoint any abnormal electrical signals that are causing your atrial flutter and where those signals are coming from. Sometimes, it’s possible to treat atrial flutter during this test. […] Lung function tests. Atrial flutter sometimes occurs in people who have lung disease. Chronic obstructive pulmonary disease (COPD) is a risk factor for atrial flutter. Your doctor may order a series of tests to determine how well your lungs work. These could provide clues regarding your atrial flutter. […] Blood tests. Your doctor will order blood tests to determine if you have an overactive thyroid, which can cause atrial flutter.

• #3 Atrial Flutter, Typical and Atypical: A Review | AER Journal

  https://www.aerjournal.com/articles/atrial-flutter-typical-and-atypical-review?language_content_entity=en

  Clinical electrophysiology has made the traditional classification of rapid atrial rhythms into flutter and tachycardia of little clinical use. […] In patients without a history of heart disease, cardiac surgery or catheter ablation, typical flutter ECG remains predictive of a right atrial re-entry circuit dependent on the inferior vena cavatricuspid isthmus that can be very effectively treated by ablation, although late incidence of atrial fibrillation remains a problem. […] In patients subjected to cardiac surgery or catheter ablation for the treatment of atrial fibrillation or showing atypical ECG patterns, macro-re-entrant and focal tachycardia mechanisms can be very complex and electrophysiological studies are necessary to guide ablation treatment in poorly tolerated cases. […] It should be emphasised that ECG diagnosis is based on atrial deflections and not on ventricular (QRS) rate and rhythm.

• #3 Diagnosis and Treatment of Atrial Flutter Circuits | SpringerLink

  https://link.springer.com/chapter/10.1007/978-88-470-2103-7_47

  Typical atrial flutter has a well-defined pattern in surface electrocardiography and is manifest by either negative initial forces in the inferior leads and positive forces in VI (counterclockwise) or positive flutter waves in the inferior leads and negative flutter waves in VI (clockwise). […] Isthmus-dependent flutter has been found to rotate around the tricuspid annulus. […] The typical patterns are isthmus-dependent and are readily ablated by producing bidirectional isthmus block.

• #3 Atrial Flutter, Typical and Atypical: A Review | AER Journal

  https://www.aerjournal.com/articles/atrial-flutter-typical-and-atypical-review?language_content_entity=en

  Radiofrequency catheter ablation of the CTI has become a standard treatment for typical flutter. […] The recurrence rate of typical flutter is 10 % after successful CTI ablation and definitive flutter suppression can be attained by a second procedure in recurrent cases. […] The main problem is the incidence of AF after ablation, which can be 30-50 % in the long term (3 years). […] Atypical flutter is often associated with structural heart disease, especially in patients that have undergone cardiac surgery or extensive catheter ablation for the treatment of AF. […] Management of atypical flutter does not differ from that of typical flutter, but the more frequent association with structural heart disease and the multiple possible mechanisms causing an atypical ECG pattern are important factors to consider before making therapeutic decisions.

• #3 Atrial Flutter (AFL): Abnormal Heart Rhythm | Doctor

  https://patient.info/doctor/atrial-flutter

  Patients with atrial flutter should be given antithrombotic therapy in the same manner as those with atrial fibrillation. The CHA2DS2-VASc stroke risk score should be used to assess stroke risk and the HAS-BLED score to assess bleeding risk in people with atrial flutter. […] Cardioversion of atrial flutter presents similar risks to cardioversion of atrial fibrillation and therefore requires similar anticoagulation.

• #3 Atrial flutter – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000224

  Atrial flutter is typically characterised on the ECG by flutter waves, which are a saw-tooth pattern of atrial activation, most prominent in leads II, III, aVF, and V1. […] Atrial rates are typically above 250 bpm and up to 320 bpm. […] Ventricular rates range from 120 to 160 bpm, and most characteristically 150 bpm, because an associated 2:1 atrioventricular block is common. […] If a patient is haemodynamically unstable, they should be given emergency electrical cardioversion. […] If a patient is haemodynamically stable, the first-line treatment is rate control and management of the underlying cause. […] If the rhythm persists in a haemodynamically stable patient, despite rate control and treatment of the underlying cause (or in the absence of a reversible cause), electrical cardioversion is used to terminate the arrhythmia.

• #3 Atrial flutter: Symptoms, Causes, Risks, Complications, Diagnosis, Treatment, Prevention Strategies

  https://ghealth121.com/treatments/atrial-flutter/

  Diagnosing atrial flutter involves a thorough examination, including listening to the heart and checking blood pressure. A healthcare provider will typically inquire about symptoms, lifestyle habits, and medical history. […] To confirm a diagnosis and identify potential underlying conditions, several tests may be conducted: Blood Tests: These assess overall health and check for conditions affecting the heart. Electrocardiogram (ECG): This quick test evaluates the heart’s electrical activity and rhythm. Holter Monitor: A portable ECG device worn for an extended period to capture heart activity during daily activities. Event Recorder: Similar to a Holter monitor, but used for shorter durations to capture irregular heart rhythms. Echocardiogram: This ultrasound test visualizes the heart’s structure and function. Stress Tests: These assess the heart’s performance under physical strain. CT Scan: This may be used to check for blood clots in the lungs. Electrophysiological Study: This invasive test pinpoints where faulty electrical signals originate within the heart.

• #4 Atrial Flutter: What It Feels Like and How It’s Treated

  https://www.verywellhealth.com/atrial-flutter-3961691

  The diagnosis of atrial flutter starts with the detection of arrhythmia on an electrocardiogram (ECG), which records the pattern of electrical activity during a heartbeat. […] For atrial flutters, the heart specialist will look for what is called flutter waves. Flutter waves look like a sawtooth pattern (called P waves) between larger spikes (called R waves). What distinguishes atrial flutter is that the P and R waves well regularly spaced and sized. […] In addition to ECG, an echocardiogram is typically used in people newly diagnosed with atrial flutters. The specialized form of ultrasound uses high-frequency sound waves to generate highly detailed images of the heart muscle and valves. […] An echocardiogram can help detect medical conditions that might affect treatment decisions, such as heart valve disorders or the presence of clots. […] Atrial flutters are diagnosed with an ECG to show the electrical impulses of your heart.

• #4 Efficacy of Adenosine in the Differential Diagnosis of Narrow QRS Complex Tachyarrhythmia: A Case Diagnosed with Atrial Flutter After Adenosine – Journal of Pediatric Emergency and Intensive Care Medicine

  https://www.caybdergi.com/articles/efficacy-of-adenosine-in-the-differential-diagnosis-of-narrow-qrs-complex-tachyarrhythmia-a-case-diagnosed-with-atrial-flutter-after-adenosine/doi/cayd.galenos.2022.17136

  Adenosine has a negative dromotropic effect at the level of the AV node when administered rapidly intravenously. […] Atrial flutter is usually diagnosed by the presence of typical sawtooth-like flutter waves on an electrocardiogram. […] The mechanism of atrial flutter is macro reentry within the atrial wall. […] In our patient, while the ventricular rate was approximately 250/min before the administration of adenosine, ECG taken during adenosine push showed an atrial rate of 500/min (typical atrial flutter with 2:1 AV block). […] Atrial flutter, which was masked after adenosine, was also revealed in our patient. […] In conclusion, if the ECG is inconsistent with typical SVT in narrow QRS complex tachycardias, another possible underlying arrhythmia should be considered, and response to treatment with adenosine should be evaluated.

• #4 Atrial Flutter | Conditions | UCSF Benioff Children’s Hospitals

  https://www.ucsfbenioffchildrens.org/conditions/atrial-flutter

  An exercise stress or treadmill test records the electrical activity of your child’s heart during exercise, which differs from the heart’s electrical activity at rest. […] This is a small monitor about the size of a pager that your child can have for up to a month. Since the arrhythmia may occur at unpredictable times, this will help to record the abnormal rhythm when your child is experiencing symptoms. He or she can just push a button on the pager and record the heartbeat. The recording can than be transmitted by phone to the doctor. […] A Holter monitor is a small, portable machine that your child wears for 24 hours. It is about the size of a portable tape player and provides a continuous 24-hour recording of your child’s heartbeat onto a tape. You will be asked to keep a diary of your child’s activities and symptoms. This monitor may detect arrhythmias that might not show up on a resting electrocardiogram, which only records a heartbeat for a few seconds at rest.

• #4 Atrial Flutter Topic Review

  https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/atrial-flutter

  Diagnosing a left atrial appendage thrombus which can result in thromboembolism, frequently causing stroke must be done using transesophageal echocardiography or cardiac CT (less commonly used). It is important to note that transthoracic echocardiography does not detect left atrial appendage thrombi in the vast majority of patients. TEE findings of a LAA thrombus include direct visualization of a mobile echodensity within the appendage. The echodensity should move independent of the walls of the atrium; this helps to distinguish artifact from thrombus. Pulse wave Doppler can be used in the LAA to determine the flow velocity. A velocity of less than 0.4 meters/second indicates a higher risk in general for thromboembolism.

• #4 Atrial flutter: common and main atypical forms

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-11/Atrial-flutter-common-and-main-atypical-forms

  The ablation procedure’s main target is to achieve bidirectional block through the cavotricuspid isthmus (CTI). […] Eletrophysiological studies are indicated in AFL-II recurrences despite optimised medical treatment. […] During EPs, the diagnosis and an accurate characterisation of the circuit may be performed by activation and postpacing interval maps, which requires 3D navigation systems. […] The acute ablation success is inferior to common atrial flutter ablation, probably due to multifactorial issues such as worse clinical baseline characteristics, multiple concomitants atypical atrial flutters, and the instability of the clinical flutter during the procedure. […] Better knowledge of the underlying mechanisms will probably help to increase accurate diagnoses of common atrial flutter as well as the main atypical forms by cardiologists and emergency department physicians.

• #4 Atrial Flutter (AFL): Abnormal Heart Rhythm | Doctor

  https://patient.info/doctor/atrial-flutter

  Atrial flutter is characterised by an abnormal and rapid heart rhythm. There is typically an atrial rate of around 300 beats per minute (bpm) and a ventricular rate that may be fixed or be variable. […] The common form of typical atrial flutter has saw-tooth flutter waves, best seen in leads II, III, and aVF, with atrial rates of 240-340 bpm. […] Further assessment is focused on identifying any specific underlying cause and an assessment of cardiac function. […] Electrocardiogram: The common form of typical atrial flutter has saw-tooth flutter waves, best seen in leads II, III, and aVF, with atrial rates of 240-340 bpm. […] Investigations for associated causes: CXR, TFTs, FBC, ESR, renal function and LFTs. […] If the atrial flutter has persisted for more than 48 hours then adequate anticoagulation is required before cardioversion to avoid the complication of emboli.

• #4 Atrial Flutter ECG Review

  https://www.healio.com/cardiology/learn-the-heart/ecg-review/ecg-topic-reviews-and-criteria/atrial-flutter-review

  Atrial flutter can described as typical (type I) or atypical (type II) based on the anatomic location from which it originates. […] Typical atrial flutter rotates counterclockwise in direction, from a reentrant circuit around the tricuspid valve annulus and through the cavo-tricuspid isthmus. […] Atypical atrial flutter originates from the left atrium or areas in the right atrium, such as surgical scars, and has a variable appearance on ECG in regards to the flutter waves.

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• #4 Atrial Flutter | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/17963

  Patients with atrial flutter have a similar risk of strokes as those with atrial fibrillation. […] The prognosis of patients with typical atrial flutter undergoing catheter ablation is good, with a recurrence rate of less than 5%. […] The most common complication of atrial flutter is the increased risk of embolic stroke and disability related to this event.

• #4 Atrial Flutter: Causes, Symptoms, Complications, Diagnosis, and Treatment | Everyday Health

  https://www.everydayhealth.com/atrial-fibrillation/guide/atrial-flutter/

  Atrial flutter is diagnosed based on your medical and family history, a physical exam, and an EKG, according to the Merck Manual. […] If an EKG shows that you have atrial flutter (shown by the sawtooth pattern), your doctor may also conduct an ultrasound of your heart (echocardiogram) to evaluate your heart and spot any blood clots. […] Treatment of atrial flutter focuses on slowing the heart rate, reducing the risk of stroke, and converting the flutter to a normal rhythm driven by the sinus node. […] Several classes of medication can help slow your heart rate, including beta blockers, calcium channel blockers, and digoxin. […] A procedure called electrical cardioversion in which you’re given a brief, low-power electrical shock through your chest while under anesthesia is often used to restore a normal sinus heart rhythm. […] Antiarrhythmic medication, such as sodium-channel or potassium-channel blockers, may help restore a normal rhythm or maintain normal rhythm after electrical cardioversion. […] Alternatively, your doctor may advise radio frequency ablation to convert an atrial flutter to normal sinus rhythm.

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