Migotanie przedsionków typu trzepotanie

Migotanie przedsionków typu trzepotanie
Etiologia i przyczyny

Trzepotanie przedsionków to zaburzenie rytmu serca charakteryzujące się szybkim, regularnym rytmem przedsionków o częstości około 250-300 uderzeń na minutę, wynikające z mechanizmu re-entry w prawym przedsionku wokół zastawki trójdzielnej, z kluczową rolą cieśni trójdzielno-żylnej (CTI). W odróżnieniu od migotania przedsionków, trzepotanie cechuje się zorganizowanym wzorcem elektrycznym, widocznym jako obraz „zębów piły” w EKG. Etiologia jest wieloczynnikowa, obejmując choroby serca (choroba wieńcowa, nadciśnienie tętnicze, zastawkowe wady serca, niewydolność serca, kardiomiopatie), stany po zabiegach kardiochirurgicznych, choroby płuc (POChP, obturacyjny bezdech senny), zaburzenia endokrynologiczne (nadczynność tarczycy), a także czynniki środowiskowe i farmakologiczne (alkohol, kofeina, leki, stres). Genetyczna predyspozycja, m.in. mutacje w genie PITX2 na chromosomie 4q25, może zwiększać ryzyko rozwoju trzepotania przedsionków.

Etiologia, przyczyny i czynniki wywołujące migotanie przedsionków typu trzepotanie

Trzepotanie przedsionków to zaburzenie rytmu serca charakteryzujące się szybkim i regularnym rytmem przedsionków, zwykle z częstością około 250-300 uderzeń na minutę. Powstaje w wyniku zaburzeń w elektrycznym układzie przewodzącym serca, który kontroluje rytm serca.¹² W przeciwieństwie do migotania przedsionków, które jest chaotyczne, trzepotanie przedsionków cechuje się bardziej zorganizowanym wzorcem elektrycznym, co daje charakterystyczny obraz „zębów piły” w zapisie EKG.³

Mechanizm powstania trzepotania przedsionków

U podstaw trzepotania przedsionków leży mechanizm re-entry, czyli nawrotny obwód elektryczny w przedsionkach. Aby powstał ten obwód elektryczny, muszą wystąpić następujące elementy:⁴

Obszary o różnej szybkości przewodzenia impulsu elektrycznego
Różne okresy refrakcji (niewrażliwości) tkanki
Funkcjonalny rdzeń, wokół którego krąży impuls elektryczny

⁴

W typowym trzepotaniu przedsionków obwód re-entry formuje się najczęściej w prawym przedsionku, wokół zastawki trójdzielnej, z kluczowym elementem zwanym cieśnią trójdzielno-żylną (CTI).⁵ Inicjacja trzepotania przedsionków następuje, gdy pobudzenie ektopowe depolaryzuje jeden segment drogi obwodu, który staje się niewrażliwy (refrakcyjny), a tachykardia rozpoczyna się od segmentu, który pozostaje nierefrakcyjny.⁴

W przypadku trzepotania przedsionków nieprawidłowy obwód elektryczny przejmuje kontrolę nad rytmem i częstością pracy serca. Może to powodować, że komory serca również biją szybciej, choć zwykle nie tak szybko jak przedsionki.⁶

Schorzenia i stany chorobowe związane z trzepotaniem przedsionków

Trzepotanie przedsionków często wiąże się z różnymi chorobami serca i innymi schorzeniami. W badaniach epidemiologicznych wykazano, że około 30% pacjentów z trzepotaniem przedsionków ma chorobę wieńcową, 30% ma chorobę serca związaną z nadciśnieniem tętniczym, a 30% nie ma podstawowej choroby serca.⁷ Wśród najczęstszych chorób i stanów predysponujących do wystąpienia trzepotania przedsionków można wymienić:

Choroby serca

Nadciśnienie tętnicze – uważane historycznie za najczęstszą przyczynę trzepotania przedsionków⁸⁹
Choroba wieńcowa i zmniejszony przepływ krwi do serca (niedokrwienie)¹⁰¹¹
Zastawkowe wady serca – prowadzą do powiększenia przedsionków¹²²
Niewydolność serca¹³⁹
Kardiomiopatia (choroba mięśnia sercowego)¹¹¹⁴
Przebyty zawał mięśnia sercowego¹⁵¹⁶
Wrodzone wady serca⁹²
Zapalenie osierdzia¹⁷
Zespół chorego węzła zatokowego¹⁷

Interwencje kardiochirurgiczne

Operacje serca – trzepotanie przedsionków może wystąpić jako powikłanie po zabiegach kardiochirurgicznych⁶¹⁸
Wcześniejsza ablacja – szczególnie ablacja z powodu migotania przedsionków¹¹¹⁸
Blizny po interwencjach kardiochirurgicznych – mogą tworzyć podłoże dla nietypowego trzepotania przedsionków¹⁹

Choroby układu oddechowego

Przewlekła obturacyjna choroba płuc (POChP)⁷²⁰
Rozedma płuc²¹
Zatorowość płucna²²⁷
Obturacyjny bezdech senny – obecny u około 40% pacjentów z trzepotaniem przedsionków⁸²³

Zaburzenia endokrynologiczne

Nadczynność tarczycy (hipertyreoza)⁹²²
Cukrzyca⁷¹⁵
Guz chromochłonny (pheochromocytoma)⁷

Inne schorzenia

Otyłość²³⁷
Zaburzenia elektrolitowe⁷
Ciężkie choroby ogólnoustrojowe lub infekcje²⁴²⁵
Niewydolność nerek²³

Czynniki stylu życia i substancje wyzwalające

Oprócz chorób i stanów chorobowych, trzepotanie przedsionków może być wyzwalane przez różne czynniki związane ze stylem życia i substancje:²⁵

Alkohol – szczególnie nadużywanie alkoholu lub picie jednorazowo dużych ilości²⁶²⁰
Kofeina – nadmierne spożycie²⁷²⁵
Nikotyna i palenie tytoniu¹⁴²⁵
Substancje stymulujące – kokaina, amfetamina²²¹
Niektóre leki – w tym leki na przeziębienie, leki dietetyczne²¹⁹
Stres emocjonalny²⁷²⁵
Intensywny wysiłek fizyczny¹⁴
Niedobór snu²⁷²⁵
Niestrawność²⁷

Leki i toksyny

Niektóre leki mogą zwiększać ryzyko wystąpienia trzepotania przedsionków lub wyzwalać jego epizody:²⁸

Toksyczność digoksyny – może powodować trzepotanie przedsionków z wysokim stopniem bloku przedsionkowo-komorowego²⁹⁷
Niesteroidowe leki przeciwzapalne (NLPZ) – zwiększają ryzyko względne rozwoju trzepotania lub migotania przedsionków o 40-70%, szczególnie przy rozpoczynaniu ich stosowania²⁸
Leki stosowane w leczeniu migotania przedsionków – paradoksalnie mogą czasem prowadzić do powstania trzepotania przedsionków³⁰³¹

Czynniki genetyczne

Chociaż nie ma jasno zdefiniowanych chorób genetycznych bezpośrednio powodujących trzepotanie przedsionków, w wielu przypadkach może istnieć genetyczna predyspozycja do jego rozwoju:³²

Badania asocjacyjne całego genomu zidentyfikowały geny związane z trzepotaniem przedsionków
Gen PITX2 (paired-like homeodomain 2) na chromosomie 4q25, który odgrywa główną rolę w asymetrii lewo-prawej serca, wykazuje silny związek z migotaniem przedsionków i jeszcze silniejszy związek z typowym trzepotaniem przedsionków

³²

Przypadki bez uchwytnej przyczyny

Istnieje również pewna grupa pacjentów, u których nie udaje się zidentyfikować konkretnej przyczyny trzepotania przedsionków:

Idiopatyczne (samoistne) trzepotanie przedsionków – występuje u osób bez chorób serca i innych zidentyfikowanych czynników ryzyka³³
Pierwotne trzepotanie przedsionków – bez podstawowych problemów zdrowotnych²⁷

Jednak „samotne” trzepotanie przedsionków (bez rozpoznawalnej choroby podstawowej) jest rzadkie, stanowiąc tylko około 2% przypadków trzepotania przedsionków.²⁵

Specyficzne grupy pacjentów

Trzepotanie przedsionków u sportowców

U sportowców wyczynowych, szczególnie uprawiających sporty wytrzymałościowe, istnieje zwiększone ryzyko rozwoju trzepotania przedsionków.²⁸ Przyczyną może być przebudowa strukturalna serca w odpowiedzi na intensywny, długotrwały trening.³⁴

Trzepotanie przedsionków u dzieci

Trzepotanie przedsionków u dzieci występuje najczęściej u noworodków i zwykle jest spowodowane względną niedojrzałością układu elektrycznego serca.³⁵ U starszych dzieci trzepotanie przedsionków jest bardzo rzadkie i prawie zawsze występuje w kontekście wad wrodzonych serca lub po operacjach kardiochirurgicznych.³⁵

Trzepotanie przedsionków u osób starszych

Ryzyko trzepotania przedsionków rośnie wraz z wiekiem, który jest najważniejszym czynnikiem ryzyka.²⁸ U osób starszych trzepotanie przedsionków częściej współistnieje z innymi chorobami serca i schorzeniami ogólnoustrojowymi.³⁶

Różnice i powiązania z migotaniem przedsionków

Trzepotanie przedsionków i migotanie przedsionków to dwa odrębne, ale powiązane ze sobą zaburzenia rytmu serca:³⁷

Około 1/3 pacjentów z trzepotaniem przedsionków ma również migotanie przedsionków³⁷
U około 50% pacjentów, którzy początkowo mają samo trzepotanie przedsionków, w ciągu 8 lat rozwinie się migotanie przedsionków²⁸
Trzepotanie przedsionków może być następstwem leczenia migotania przedsionków³¹
Nieleczone trzepotanie przedsionków może prowadzić do migotania przedsionków³⁸

Epidemiologia i czynniki ryzyka

Trzepotanie przedsionków jest mniej powszechne niż migotanie przedsionków i stanowi około 1/10 częstości występowania migotania przedsionków.²⁸ Epidemiologia trzepotania przedsionków nie jest tak dobrze zbadana jak w przypadku migotania przedsionków.²⁸

Główne czynniki ryzyka trzepotania przedsionków obejmują:³⁴³⁶

Wiek – ryzyko rośnie z wiekiem
Płeć męska – około 80% pacjentów z trzepotaniem przedsionków to mężczyźni
Powiększenie lewego przedsionka – jeden z najsilniejszych czynników predykcyjnych
Zaburzenia funkcji rezerwuarowej lewego przedsionka
Strukturalne nieprawidłowości serca

Niektóre z powyższych czynników ryzyka nakładają się na te związane z migotaniem przedsionków, co może wyjaśniać częste współwystępowanie obu zaburzeń rytmu.³⁹

Konsekwencje i powikłania

Trzepotanie przedsionków, jeśli nie jest leczone, może prowadzić do poważnych powikłań:³⁸⁴⁰

Zwiększone ryzyko udaru mózgu – z powodu zastoju krwi w przedsionkach i tworzenia się skrzeplin, chociaż ryzyko wydaje się być około połowę mniejsze niż w przypadku migotania przedsionków⁴¹
Kardiomiopatia wywołana tachykardią – długotrwałe, nieleczone epizody trzepotania przedsionków z szybką częstością komór mogą prowadzić do osłabienia mięśnia sercowego³⁸
Niewydolność serca – w wyniku długotrwałego, szybkiego rytmu serca³⁸
Negatywna przebudowa przedsionków – z powiększeniem i osłabieniem przedsionków (miopatia)⁴²
Progresja do migotania przedsionków³⁸

Podsumowanie przyczyn trzepotania przedsionków

Trzepotanie przedsionków to złożone zaburzenie rytmu serca z wieloma potencjalnymi przyczynami. U większości pacjentów występuje ono w kontekście istniejącej choroby serca lub innego schorzenia, chociaż w niektórych przypadkach nie można zidentyfikować konkretnej przyczyny. Mechanizm re-entry w przedsionkach, szczególnie wokół zastawki trójdzielnej, jest kluczowym elementem patofizjologicznym. Znajomość przyczyn i czynników ryzyka trzepotania przedsionków jest niezbędna do skutecznego zapobiegania, diagnozowania i leczenia tego zaburzenia rytmu serca.⁸⁵

Profilaktyka trzepotania przedsionków koncentruje się na kontrolowaniu lub zapobieganiu czynnikom ryzyka, takim jak utrzymywanie zdrowej masy ciała, umiarkowane spożywanie alkoholu lub całkowita abstynencja, zaprzestanie używania tytoniu oraz kontrolowanie nadciśnienia tętniczego i cukrzycy.³⁴ Ze względu na ryzyko powikłań zakrzepowo-zatorowych, pacjenci z przewlekłym lub nawracającym trzepotaniem przedsionków wymagają odpowiedniego leczenia przeciwkrzepliwego.⁴¹

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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. […] 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.
#2 Atrial Flutter: Types, Symptoms, Causes, Tests, and Treatments
https://www.webmd.com/heart-disease/atrial-fibrillation/atrial-flutter
Atrial flutter is a type of irregular heartbeat, or an arrhythmia. It causes your heart to beat too fast. […] Doctors dont always know what causes atrial flutter. In some people, no root cause is ever found. But atrial flutter can result from damage to the heart caused by a variety of conditions. […] Heart conditions that can cause atrial flutter include: High blood pressure (hypertension), Coronary artery disease, Heart valve disorders, Congenital heart defects (these are defects you are born with), Heart surgery. […] Other causes of atrial flutter include: Overactive thyroid gland, or hyperthyroidism, Alcohol abuse, Overuse of stimulants, like cocaine, amphetamines, diet pills, cold medicines, and even caffeine.
#3 Atrial Flutter: Causes, Symptoms, Complications, Diagnosis, and Treatment | Everyday Health
https://www.everydayhealth.com/atrial-fibrillation/guide/atrial-flutter/
Atrial flutter is a heart disorder in which the heart beats out of its normal rhythm. […] Atrial flutter develops from health conditions that affect the hearts internal electrical system. […] Atrial flutter causes the heart to beat in a fast but regular pattern unlike afib, which causes a fast and irregular pattern. […] Atrial flutter produces a distinctive sawtooth pattern on an electrocardiogram (EKG or ECG), a test used to monitor the heart and diagnose heart rhythm disorders. […] In people with atrial flutter, the hearts electrical signal gets stuck repeating in the right atrium, causing the atria to contract rapidly (about 300 times per minute). […] Like afib, atrial flutter develops from health conditions that affect the hearts internal electrical system.
#4 Atrial Flutter – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK540985/
The etiology behind atrial flutter is the presence of a re-entry mechanism for the initiation of the tachycardia. To have this electrical circuit, one must have the following elements: Areas with fast and slow velocities of conduction, Different refractory periods, A functional core where the circuit exists. […] These elements are present in a typical atrial flutter in the CTI. The initiation of atrial flutter is due to an ectopic beat that depolarizes 1 segment of the pathway of the circuits that become refractory and starts the tachycardia from a no-refractory segment.
#5 Atrial Flutter | Treatment & Management | Point of Care
https://www.statpearls.com/point-of-care/17963
The etiology behind atrial flutter is the presence of a re-entry mechanism for the initiation of the tachycardia. To have this electrical circuit, one must have the following elements: Areas with fast and slow velocities of conduction, Different refractory periods, A functional core where the circuit exists. These elements are present in a typical atrial flutter in the CTI. The initiation of atrial flutter is due to an ectopic beat that depolarizes 1 segment of the pathway of the circuits that become refractory and starts the tachycardia from a no-refractory segment. […] Atrial flutter is commonly associated with atrial fibrillation, but the incidence and the prevalence of the atrial flutter are less known when compared with atrial fibrillation. Atrial flutter is common in patients with underlying diseases such as chronic obstructive pulmonary disease, pulmonary hypertension, and heart failure. Isolated atrial flutter in the absence of abnormal heart anatomy is rare and usually occurs when atrial size abnormalities have developed.
#6 Atrial Flutter
https://healthlibrary.uwmedicine.org/Search/134,229
Atrial flutter is one of the more common abnormal heart rhythms (arrhythmias). It’s caused by an abnormal electrical circuit in the upper chambers of the heart (atria) that makes the atria beat quickly and flutter instead of fully squeezing. […] In atrial flutter, an abnormal electrical circuit forms in the atria. This causes abnormally frequent contractions in the upper chambers. This new circuit takes over the heart rhythm and rate. It may cause the lower chambers of the heart (ventricles) to beat fast too, but often not as fast as the atria. This often happens after some types of heart surgery, heart muscle damage, or other heart changes. […] Atrial flutter is often linked to a similar heart rhythm called atrial fibrillation (AFib). AFib is the most common type of arrhythmia.
#7 Atrial Flutter: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/151210-overview
Atrial flutter is associated with a variety of cardiac disorders. In most studies, approximately 30% of patients with atrial flutter have coronary artery disease, 30% have hypertensive heart disease, and 30% have no underlying cardiac disease. Rheumatic heart disease, congenital heart disease, pericarditis, and cardiomyopathy may also lead to atrial flutter. Rarely, mitral valve prolapse or acute myocardial infarction has been associated with atrial flutter. […] In addition, the following conditions are also associated with atrial flutter: Hypoxia, Chronic obstructive pulmonary disease, Pulmonary embolism, Hyperthyroidism, Pheochromocytoma, Diabetes, Electrolyte imbalance, Alcohol consumption, Obesity, Digitalis toxicity, Myotonic dystrophy in childhood (rare). […] Atrial flutter may be a sequela of open heart surgery. After cardiac surgery, atrial flutter may be reentrant as a result of natural barriers, atrial incisions, and other cardiac scars. Some patients develop atypical left atrial flutter after pulmonary vein isolation procedures for atrial fibrillation.
#8 Atrial Flutter Topic Review
https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/atrial-flutter
Typical atrial flutter results from a reentrant circuit around the tricuspid valve and through the cavo-tricuspid isthmus. […] The etiology of atrial flutter is similar to that of atrial fibrillation. Identifying the etiology of cannot be under-emphasized, as treating the cause is frequently necessary to eliminate recurrences of atrial flutter. […] The classic mnemonic PIRATES encompasses a vast majority of the causes: […] Historically, hypertension was thought to be the most common cause of atrial flutter; however, obstructive sleep apnea is present in about 40% of patients, and it is well known that OSA causes hypertension. The exact proportion of atrial flutter caused directly by OSA remains unclear.
#9 Atrial Flutter: Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/22885-atrial-flutter
Atrial flutter is a fast heart rhythm that happens because of abnormal electrical signals. […] Electrical signals that are too frequent cause atrial flutter, making the upper chambers of your heart contract (pump) too often. Atrial flutter causes include: Heart valve disorders, Congenital heart conditions (present at birth), Coronary artery disease, Heart failure, High blood pressure, Overactive thyroid. […] Your risk of atrial flutter increases as you age. Men are also at a higher risk. Medical conditions that can raise your risk include: Other heart issues, like heart failure or a valve issue, High blood pressure, A thyroid that isnt working right (hyperthyroidism), Diabetes, Lung disease, A history of alcohol use disorder, Obstructive sleep apnea, Obesity.
#10 What is Atrial Flutter? | American Heart Association
https://www.heart.org/en/health-topics/atrial-fibrillation/what-is-atrial-fibrillation-afib-or-af/atrial-flutter
Atrial flutter is a rhythmic disturbance of the heart (arrhythmia). Atrial flutter happens when the chambers beat faster than normal and are not always coordinated. […] The cause of atrial flutter may be unknown. In some cases, it is the result of damage to the heartâs electrical system. This may be caused by other conditions such as: Long-term, uncontrolled high blood pressure, Coronary artery disease, Heart valve disorders, Birth defects of the heart, Alcohol abuse, Overactive thyroid gland.
#11 Atrial Flutter: Causes, Symptoms, and Diagnosis
https://www.healthline.com/health/heart-disease/atrial-flutter
Atrial flutter is thought to result from damage to the heart, its electrical system, or to parts of the body that affect the heart. […] Researchers have linked many factors to the disruption in the hearts electrical circuitry that causes AFL. It is sometimes difficult to pinpoint the precise root cause. […] Underlying heart disease or abnormalities are a major cause of AFL. Examples include: scarring from previous heart surgery or cardiac ablation, a nonsurgical procedure for treating both AFL and AFib, decreased blood flow to the heart (ischemia), usually resulting from hardening of the arteries (atherosclerosis) or blood clot, high blood pressure, disease of the heart muscle (cardiomyopathy), heart valve disorders, enlarged heart chamber (hypertrophy or dilation), heart incident, such as a heart attack, blood clot in the lungs, Non-cardiac surgery.
#12 Atrial Fibrillation and Atrial Flutter – Heart and Blood Vessel Disorders – Merck Manual Consumer Version
https://www.merckmanuals.com/home/heart-and-blood-vessel-disorders/abnormal-heart-rhythms/atrial-fibrillation-and-atrial-flutter
Atrial fibrillation or atrial flutter may occur even when there is no other heart disorder. More often, these arrhythmias are caused by such conditions as […] Heart valve disorders and high blood pressure cause the atria to enlarge, making atrial fibrillation or atrial flutter more likely.
#13 Atrial Flutter (AFL) | UpBeat.org – powered by the Heart Rhythm Society
https://upbeat.org/heart-rhythm-disorders/atrial-flutter
Atrial flutter is similar to AFib because it also occurs in the atria or upper chambers of the heart and can result in a fast heartbeat. However, AFL tends to be an organized rhythm that is caused by an electrical wave that circulates very rapidly in the atrium, about 300 times a minute. […] With AFL, the electrical signal travels along a pathway within the right atrium. It moves in an organized abnormal circular motion, or „circuit,” causing the atria to beat faster than the ventricles of your heart. […] Some medical conditions increase the risk for developing AFL. These medical conditions include: Heart failure, Previous heart attack, Acquired or congenital valve abnormalities, High blood pressure, Recent upper chamber surgery, Thyroid dysfunction, Alcoholism (especially binge drinking), Chronic lung disease, Acute (serious) illness, Diabetes.
#14 Atrial Flutter | Cardiology | Mercy Health
https://www.mercy.com/health-care-services/heart-vascular/conditions/atrial-flutter
Atrial flutter can be caused by a variety of heart conditions including: High blood pressure, Cardiomyopathy, Coronary artery disease, Atherosclerosis. […] Other factors that can cause atrial flutter include: Panic attacks, Strenuous physical activity, Caffeine, nicotine, alcohol or illegal drugs, Medications.
#15 Atrial Flutter: Symptoms, Causes, Treatment | Mass General Brigham
https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/atrial-flutter
Atrial flutters originate from an error in the heart’s electrical system. […] The specific causes of atrial flutter in any given case are often unknown. However, some variables contribute to the risk of developing these heart flutters. […] Several medical conditions may increase your risk of developing atrial flutter, such as: Alcoholism, Chronic lung disease, Diabetes, Heart attacks, Heart failure, Heart surgery, Heart valve abnormalities, High blood pressure, Thyroid dysfunction.
#16
#17 Atrial fibrillation and atrial flutter: MedlinePlus Medical EncyclopediaLock
https://medlineplus.gov/ency/article/000184.htm
Atrial fibrillation (Afib) and atrial flutter are common types of abnormal heart rhythms (arrhythmias) which affect the upper chambers (atria) of the heart. […] Common causes of AFib include: Alcohol use (especially binge drinking), Coronary artery disease, Heart attack or heart bypass surgery, Heart failure or an enlarged heart, Heart valve disease (most often the mitral valve), Hypertension, Medicines, Overactive thyroid gland (hyperthyroidism), Pericarditis, Sick sinus syndrome. […] Talk to your provider about steps to treat conditions that cause atrial fibrillation and flutter. Avoid binge drinking.
#18 Atrial Flutter: Causes, Symptoms & Treatment | Tampa General Hospital
https://www.tgh.org/institutes-and-services/conditions/atrial-flutter
Atrial flutter is a type of abnormal heartbeat, or arrhythmia. […] There are various risk factors that can increase the chances of developing atrial flutter, including: […] Being over age 50 […] Having previously undergone catheter ablation to treat atrial fibrillation […] Having previously undergone cardiac surgery.
#19 Treating Atrial Flutter Symptoms | University of Utah Health | University of Utah Health
https://healthcare.utah.edu/cardiovascular/conditions/atrial-flutter
Atrial flutter is a type of arrhythmia (heart rhythm disorder) caused by a short circuit in the electrical system. […] Atypical atrial flutter is caused by scarring on the left side of the heart from prior heart surgeries, previous procedures, or heart disease. […] Atrial flutter is much more common in people over the age of 50, and your risk increases with age. It can occur due to diseases or other problems in the heart or by a disease somewhere else in your body that affects your heart. […] A heart attack, coronary artery disease, or previous heart or chest surgery on the upper chambers of your heart can also increase your risk. […] Alcohol and stimulants such as diet pills, cold medicines, and caffeine can contribute to symptoms of atrial flutter.
#20 Atrial Flutter: Causes, Symptoms, and Diagnosis
https://www.healthline.com/health/heart-disease/atrial-flutter
Conditions in other parts of the body that affect the heart can also contribute to the development of AFL. Examples include: thyroid disease, blood clots, chronic lung diseases, such as chronic obstructive pulmonary disease (COPD) or emphysema, untreated sleep apnea. […] Lifestyle factors are also thought to play a part in developing AFL. This often involves ingesting substances that might affect the electrical systems of the heart. Examples include: alcohol misuse, substance misuse, especially stimulants, smoking, ingesting certain drugs, such as diet pills or cold medications, consuming high amounts of caffeine.
#21 Atrial Flutter | Boston Medical Center
https://www.bmc.org/patient-care/conditions-we-treat/db/atrial-flutter
Atrial flutter occurs when the heart beats too quickly (typically 300 beats per minute) and therefore cannot pump blood efficiently. […] Causes of atrial flutter include coronary heart disease, myocardial infarction (heart attack), hypertension (high blood pressure), congestive heart failure, heart valve abnormalities, hyperthyroidism and/or lung diseases such as emphysema, chronic bronchitis, or asthma. In addition, some substances can contribute to atrial flutter, including alcohol, cocaine, amphetamines, and cold medicines.
#22 Atrial Flutter > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/atrial-flutter
Atrial flutter is a type of heart rhythm abnormality that usually results in the heart beating too quickly. […] Atrial flutter, a heart rhythm problem, occurs because of a malfunction in hearts electrical system, leading to a faster-than-normal heart rate. […] The following conditions, which may damage the electrical system that powers the heart, may cause atrial flutter: Heart attacks, Open-heart surgery, Chronic obstructive pulmonary disease (COPD), A blood clot in the lung (pulmonary embolism), Diabetes, Overactive thyroid (hyperthyroidism), High blood pressure (hypertension). […] Untreated atrial flutter increases the risk of stroke or cardiomyopathy.
#23 Atrial Flutter: What It Feels Like and How It’s Treated
https://www.verywellhealth.com/atrial-flutter-3961691
Atrial flutter occurs when nerves that cause contractions of the upper chambers of the heart become „trapped” due to a heart injury, surgery, or disease-related changes to the heart muscle. […] This interferes with the normal delivery of electrical impulses to the atria. As a result of the looping, the atria will beat rapidlyâusually around 250 beats per minuteâand occasionally skip a beat. […] While anyone can develop atrial flutter, it is much less common than atrial fibrillation. Risk factors for atrial flutter are the same as those for atrial fibrillation, including: Obesity, Heart failure, High blood pressure, Uncontrolled diabetes, Sleep apnea, Sick sinus syndrome, Pericarditis (caused by infection, heart attack, or autoimmune disease), Hypertrophy (enlargement and thickening) of the left chambers of the heart, Hyperthyroidism, Chronic kidney disease, Past heart surgery, Smoking.
#24 What is Atrial Flutter? | South Denver Cardiology
https://southdenver.com/typical-atrial-flutter-a-flutter/
The exact cause of atrial flutter is not always clear, but there are several factors that can increase the risk of developing this condition. Some common causes and risk factors for atrial flutter include: […] Advanced age […] Male gender […] Coronary artery disease […] Structural heart disease […] High blood pressure […] Thyroid disease […] Drinking too much alcohol, using drugs, and nicotine […] Previous heart surgery […] Heart Failure […] Diabetes […] Being Overweight […] Serious illness or infection can trigger atrial flutter […] Lung Disease […] Sleep apnea.
#25 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
Atrial flutter seems to be an easy electrocardiographic (ECG) diagnosis, which can be done by a medical student. […] Any 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. […] A first occurence of atrial flutter is in 60% of cases associated with a specific acute precipitating event (major surgery, pneumonia, myocardial infarction). […] In 38% of cases, atrial flutter is associated with chronic illness (heart failure, lung disease, hypertension). […] Lone atrial flutter (without any recognisable underlying disease) is rare only 2% of atrial flutter patients.
#26 Atrial Flutter: Symptoms, Causes, Treatment & Life Expectancy
https://www.emedicinehealth.com/atrial_flutter/article_em.htm
Atrial flutter may be caused by abnormalities of the heart, diseases of the heart, or by diseases elsewhere in the body that affect the heart. Atrial flutter may also be caused by consuming substances that change the way electrical impulses are transmitted through the heart. Atrial flutter can occur after open-heart surgery. In a few people, no underlying cause is ever found. […] Heart diseases or abnormalities that can cause atrial flutter to include the following: Decreased blood flow to the heart (ischemia) due to coronary heart disease, hardening of the arteries (atherosclerosis), and/or a heart attack. […] Diseases elsewhere in the body that affect the heart include the following: Overactive thyroid gland (hyperthyroidism). […] Substances that may contribute to atrial flutter include the following: Alcohol (wine, beer, or hard liquor).
#27
https://myhealth.alberta.ca/Alberta/Pages/atrial-flutter-symptoms-and-causes.aspx
Atrial flutter is more common in people with health conditions that have caused changes in the electrical system in their heart like: high blood pressure, a history of a heart attack, a history of heart valve disease, coronary artery disease, lung disease, thyroid problems, previous cardiac surgery, congenital heart disease. […] However, atrial flutter can also happen without any of these or other health issues. When there are no underlying health issues, its called primary atrial flutter. […] For many people there isnt anything obvious that will trigger an episode of AF. For others, triggers can be: caffeine, nicotine, alcohol, feeling tired, indigestion, emotional stress, not getting enough sleep.
#28 Atrial Flutter (AFL): Abnormal Heart Rhythm | Doctor
https://patient.info/doctor/atrial-flutter
One study found use of non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) – particularly new use – has been found to be associated with a 40-70% increased relative risk of developing atrial flutter or fibrillation. Other studies in the literature seem to relate to atrial fibrillation but a later meta-analysis found a 12% increased risk associated with NSAID use.
#28 Atrial Flutter (AFL): Abnormal Heart Rhythm | Doctor
https://patient.info/doctor/atrial-flutter
Atrial flutter is less common than atrial fibrillation, but epidemiology is less well studied. It is one tenth as common as atrial fibrillation. Atrial flutter is commonly associated with atrial fibrillation. On presentation the two often alternate. Around 50% of those presenting with atrial flutter alone are said to develop atrial fibrillation within the next eight years. […] Age is the most important risk factor. Structural abnormalities are also a strong risk factor, with left atrial dilatation possibly one of the strongest predicting factors for the likely development of atrial flutter. This explains many of the associations below. […] Coronary heart disease. Atrial dilation due to septal defects, pulmonary emboli, mitral or tricuspid valve dysfunction or chronic ventricular failure. Cardiac surgery and ablation procedures. Hypertension. Obesity. Alcohol abuse. Chronic obstructive pulmonary disease. Cardiomyopathy. Atrial myxoma. Pericarditis. Sick sinus syndrome, cardiac conduction pre-excitation syndromes – eg, Wolff-Parkinson-White syndrome. Thyrotoxicosis, phaeochromocytoma, electrolyte imbalance. Obstructive sleep apnoea. Very high-intensity sports.
#29 Atrial Flutter • LITFL • ECG Library Diagnosis
https://litfl.com/atrial-flutter-ecg-library/
Atrial flutter is a form of supraventricular tachycardia caused by a re-entry circuit within the right atrium. […] 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 combination of new-onset atrial flutter with high-grade AV block is very suspicious for digoxin toxicity.
#30 Atrial Fibrillation and Atrial Flutter in Athletes – FixAfib
https://www.fixafib.com/blog/afib-causes/atrial-fibrillation-and-atrial-flutter-in-athletes/
Atrial flutter is a type of arrhythmia which is caused by abnormal electrical signals that originate in the atria. […] A variety of conditions can predispose a person to developing atrial flutter. Causes of atrial flutter include: […] Risk factors for atrial flutter are the same as atrial fibrillation and can include obesity, sleep apnea, thyroid problems, high blood pressure, advancing age, heart failure, lung disease and structural heart disease. […] Atrial flutter can occur after the initiation of certain medications used for atrial fibrillation. […] Atrial flutter can develop after an atrial fibrillation ablation. […] Atrial flutter and atrial fibrillation are common arrhythmias which can occur after heart surgery. […] On rare occasions, atrial flutter can occur after a heart attack.
#31 Atrial flutter | informedhealth.org
https://www.informedhealth.org/atrial-flutter.html
Atrial flutter is often caused by scar-like changes to the heart muscle resulting from heart diseases such as coronary artery disease (CAD) or following heart surgery. […] Atrial flutter can develop if a signal is not passed on and gets stuck in the atrium because of a previous heart condition: The impulse than usually circles around the heart valve that connects the right atrium and the right ventricle and repeatedly stimulates the heart muscle cells in that area. […] Atrial flutter can also develop as a result of atrial fibrillation that has been treated with medication. […] Men are at more risk of atrial flutter than women. That risk increases with age. Smoking is another risk factor.
#32 Atrial Flutter: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/151210-overview
Although there are no clearly defined genetic conditions that cause atrial flutter, in many cases there is likely an underlying genetic susceptibility to acquiring it. Genome-wide association studies have identified genes associated with atrial flutter. […] The PITX2 (paired-like homeodomain 2) gene on chromosome locus 4q25 is known to play a major role in left-right asymmetry of the heart and has been found to have a strong association with atrial fibrillation and an even stronger association with typical atrial flutter.
#33 Atrial Flutter – Heart Rhythm CentreHeart Rhythm Centre
https://heartrhythm.com.au/symptom/atrial-flutter/
Atrial flutter is caused by an electrical short circuit in the heart. Some causes of electrical short circuits in the heart include high blood pressure, heart valve disease, heart muscle disease, previous heart attacks, congenital heart disease (heart disease present since birth), lung disease and previous heart surgery. […] In many cases the cause of the atrial flutter cannot be determined (this is known as idiopathic atrial flutter).
#34 Atrial Flutter
https://johnshopkinshealthcare.staywellsolutionsonline.com/library/diseasesconditions/adult/134,229
Atrial flutter is one of the more common abnormal heart rhythms (arrhythmias). It’s caused by an abnormal electrical circuit in the upper chambers of the heart (atria) that makes the atria beat quickly and flutter instead of fully squeezing. […] In atrial flutter, an abnormal electrical circuit forms in the atria. This causes abnormally frequent contractions in the upper chambers. This new circuit takes over the heart rhythm and rate. It may cause the lower chambers of the heart (ventricles) to beat fast too, but often not as fast as the atria. This often happens after some types of heart surgery, heart muscle damage, or other heart changes. […] You are more likely to have atrial flutter if any of these apply to you: Age. The older you are, the higher the risk. High blood pressure, Diabetes, Coronary artery disease, Heart failure, Heart valve disease, Congenital heart disease, Past heart surgery, Obesity, Alcohol consumption, Lung disease, Overactive thyroid (hyperthyroidism), Sleep apnea, Overexercising, such as in endurance athletes, Family history. […] Prevention of atrial flutter focuses on controlling or preventing the risk factors. Stay at a healthy weight. Drink alcohol only in moderation, if at all. Stop tobacco use. Control high blood pressure and diabetes.
#35 Atrial Flutter – Pediatric Cardiology Associates of Houston
https://www.kidsheartshouston.com/answers/21816-atrial-flutter
Atrial flutter occurs when electricity forms an abnormal circuit somewhere in the atrium. […] Atrial flutter in children is seen most commonly in newborn babies. In this setting, it is usually caused by the relative immaturity of the heart’s electrical system. […] Atrial flutter in older children is very uncommon. When it does occur, it is almost always in the setting of surgically repaired heart disease. Scar tissue caused by surgery can create a circuit in which atrial flutter may occur.
#36 Atrial Flutter | University of Iowa Health Care
https://uihc.org/services/atrial-flutter
Atrial flutter occurs when the hearts electrical system is damaged. While the direct cause is not always known, there are certain conditions that are more likely to cause atrial flutter, including: […] Typical atrial flutter: The most common type is localized in the right atrium of the heart. […] Atypical atrial flutter: This is usually caused by previous heart surgery and is most often localized in the left atrium. […] Atrial flutter is most common in older adults and those assigned male at birth. However, the following conditions can make you more likely to develop atrial flutter: […] Coronary artery disease […] Heart valve disorders […] High blood pressure […] Congenital heart disease or defects […] Overactive thyroid.
#37 The difference between atrial flutter and atrial fibrillation – BHF
https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/ask-the-experts/atrial-flutter
Atrial flutter and atrial fibrillation are both abnormal heart rhythms. They occur when there is an issue with the electrical signals and pathways in your heart, which usually help it beat in an organised, effective way. […] Atrial flutter is less common than atrial fibrillation. […] Atrial flutter is less common, but has similar symptoms (feeling faint, tiredness, palpitations, shortness of breath or dizziness). […] About a third of people with atrial flutter also have atrial fibrillation. […] Both conditions carry increased risk of stroke, usually managed by drugs (such as warfarin or a newer anticoagulant). […] Catheter ablation is usually considered the best treatment for atrial flutter.
#38 Atrial Flutter (AFL) | UpBeat.org – powered by the Heart Rhythm Society
https://upbeat.org/heart-rhythm-disorders/atrial-flutter
AFL itself is not life threatening. If left untreated, the side effects of AFL can be potentially life threatening. AFL makes it harder for the heart to pump blood effectively. With the blood moving more slowly, it is more likely to form clots. If the clot is pumped out of the heart, it could travel to the brain and lead to a stroke or heart attack. Without treatment, AFL can also cause a fast pulse rate for long periods of time. This means that the ventricles are beating too fast. When the ventricles beat too fast for long periods of time, the heart muscle can become weak and tired. This condition is called cardiomyopathy. This can lead to heart failure and long-term disability. Without treatment, AFL can also cause another type of arrhythmia called atrial fibrillation.
#39 Atrial Flutter, Typical and Atypical: A Review | AER Journal
https://www.aerjournal.com/articles/atrial-flutter-typical-and-atypical-review?language_content_entity=en
About 80 % of flutter patients are male, otherwise flutter occurs in clinical contexts very much like those observed in AF (in old age, hypertension, diabetes, chronic obstructive lung disease, excessive alcohol consumption or during endurance sports practice). […] In many cases flutter episodes alternate with fibrillation episodes. […] Of those initially presenting with flutter as the only arrhythmia, 50 % develop fibrillation during long-term follow-up. […] The thickness of the terminal crest and its capacity to block transverse conduction are increased in cases of flutter compared to AF. […] EP studies have shown areas of low-voltage electrograms and slow conduction in the RA particularly at the CTI to be a sign of arrhythmogenic myocardial remodelling. […] LA dilatation and abnormalities in its reservoir function have been described as predictors of the incidence of atrial flutter or fibrillation.
#40 Atrial Flutter
https://www.washingtonhra.com/arrhythmias/atrial-flutter.php
Atrial flutter is the result of a rapid electrical circuit localized to the top right heart chamber, the right atrium. This electrical circuit has been extensively mapped using electrophysiology-guided catheter mapping techniques. It can occur in patients with no structural heart disease (lone atrial flutter), but is more likely in those with a history of prior cardiac surgery, congestive heart failure, or congenital heart disease. Conditions that lead to right-sided heart dilation and increased pressure can increase the incidence of this rhythm disturbance (right-sided heart failure, pulmonary hypertension, COPD, hypertension, obesity, tricuspid or pulmonary stenosis). […] Atrial flutter poses an increased risk of stroke. This is a direct result of the rapid atrial contraction that leads to a stasis or pooling of blood in the atria; particularly, the left atrium. This pooled blood is more likely to form clots that can travel to the systemic circulation and the brain, leading to a cerebrovascular accident or stroke. The risk of stroke is not the same for all people with atrial flutter.
#41 Atrial Flutter – Cardiovascular Disorders – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/cardiovascular-disorders/specific-cardiac-arrhythmias/atrial-flutter
Atrial flutter is much less common than atrial fibrillation, but its causes and hemodynamic consequences are similar. […] Typical atrial flutter is due to a large reentrant circuit involving most of the right atrium and requires conduction between the orifice of the inferior vena cava and the annulus of the tricuspid valve (the cavotricuspid isthmus). […] The probability of a thromboembolic event in isolated atrial flutter is thought to be about half of that in atrial fibrillation. […] Ablation procedures designed to interrupt the atrial reentrant circuit may effectively prevent atrial flutter, particularly typical atrial flutter. […] To prevent thromboembolism, patients with chronic or recurrent atrial flutter require an oral anticoagulant (warfarin titrated to an INR of 2 to 3, a direct thrombin inhibitor, or a factor Xa inhibitor).
#42 Atrial Flutter
https://www.washingtonhra.com/arrhythmias/atrial-flutter.php
In addition to the risk of stroke, prolonged episodes of atrial flutter can cause irreversible changes to the atria, including negative remodeling with atrial enlargement and weakness (myopathy). In addition, prolonged episodes can make reversion and maintenance of normal sinus rhythm more difficult. Long-lasting atrial flutter with continuously rapid ventricular rates (heart rates typically greater than 100 beats per minute) may cause a tachycardia-induced cardiomyopathy (weakening of ventricular muscle and heart function) and symptoms of congestive heart failure.