Materiały źródłowe

• #1 Atrial Flutter

  https://healthelibrary.stillwater-medical.org/Library/Wellness/Prevention/134,229

  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.

• #2 Atrial Flutter: Symptoms & Treatment

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

  Although you cant prevent some of the risk factors for atrial flutter, limiting your alcohol intake can help. Also, you can get medical care for the problems that cause atrial flutter or put you at risk for it […] Because theres no cure for atrial flutter and it carries a high risk of stroke, youll need follow-up appointments all your life. Its important to keep your appointments because its common for atrial flutter to keep coming back. People with atrial flutter may have multiple hospital visits because of this.

• #3 Atrial Flutter: Symptoms, Causes, Treatment | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/atrial-flutter

  How to prevent atrial flutters […] While atrial flutter causes are often unknown, you can take preventative measures. Following these guidelines may not provide complete atrial flutter prevention, but they may reduce your risks. […] Avoid heavy alcohol consumption […] Avoid tobacco use […] Maintain a healthy weight […] Treat any medical conditions you have that could increase your risk of developing atrial flutter […] Treat or prevent high blood pressure

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

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

  Lifestyle changes help keep the heart healthy. Try these heart-healthy tips: […] Don’t smoke. […] Eat healthy foods such as fruits, vegetables and whole grains. Eat less salt and saturated fats. […] Exercise at least 30 minutes a day on most days of the week. […] Keep a healthy weight. […] Use less or do not use caffeine and alcohol. […] Reduce and manage stress. […] Control high blood pressure, high cholesterol and diabetes. […] Get good sleep. Adults should try to get 7 to 9 hours daily.

• #5 A Complete Guide on Treatment of Atrial Flutter ACLS

  https://aclsnow.com/blog/atrial-flutter-treatment-management-in-acls/

  There’s a saying, “Prevention is better than cure,” and this is completely true. Conditions related to the heart are crucial to prevent and treat. Preventive measures can be simple and effective if done correctly and for a prolonged period of time. Some of the preventive measures are: […] Maintaining a Healthy Body Weight: Body weight and the accumulation of unhealthy fats are among the most frequent risk factors for atrial flutter and other heart-related issues. Regular exercise and a healthy diet can help an individual maintain a healthy weight and avoid heart disease. […] Restricting the Use of Alcohol: Consuming high amounts of alcohol can lead to various health-related issues, specifically heart and liver diseases. Therefore, it’s good to avoid alcohol as much as possible. […] No Use of Tobacco Products: The common notion is that tobacco hampers only the lungs, but the prolonged use of tobacco has drastic effects on the heart and overall health. […] Keeping a Constant Check of Blood Sugar and Pressure Levels: Certain conditions, such as diabetes and high blood pressure, have negative effects on heart health, and if not checked properly, they can damage the organs.

• #6 Lifestyle Changes for Atrial Fibrillation & Atrial Flutter | NYU Langone Health

  https://nyulangone.org/conditions/atrial-fibrillation-atrial-flutter/treatments/lifestyle-changes-for-atrial-fibrillation-atrial-flutter

  People who have atrial fibrillation (AFib) and atrial flutter are at increased risk for conditions that affect the heart, such as high blood pressure, coronary artery disease, and heart attack. By following a heart-healthy lifestyle, you can limit experiences that trigger AFib or atrial flutter, as well as reduce your risk of heart disease. […] Heart specialists at NYU Langones Heart Rhythm Center recommend the following lifestyle changes for atrial flutter and atrial fibrillation management. […] A healthy diet and exercise play a major role in preventing heart disease and reducing symptoms related to AFib and atrial flutter. […] Limiting caffeine and alcohol can reduce symptoms of arrhythmia. […] If you smoke or use tobacco products, its recommended that you stop. […] To ease symptoms of sleep apnea, sleep experts may recommend reducing or eliminating alcohol and sedative use, changing your sleep position, or using a mouth guard or continuous positive airway pressure (CPAP) device that keeps the airway open while you sleep. […] Studies have shown that too much stress can raise your blood pressure and trigger AFib or atrial flutter. […] Exercise can help you lose weight and reduce high blood pressure. Taking a brisk 30-minute walk every day can improve your heart health and reduce the risk of triggering an arrhythmia.

• #7 Atrial fibrillation – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624

  Healthy lifestyle choices can reduce the risk of heart disease and may prevent atrial fibrillation (AFib). Here are some basic heart-healthy tips: […] Control high blood pressure, high cholesterol and diabetes. […] Don’t smoke or use tobacco. […] Eat a diet that’s low in salt and saturated fat. […] Exercise at least 30 minutes a day on most days of the week unless your health care team says not to. […] Get good sleep. Adults should aim for 7 to 9 hours daily. […] Maintain a healthy weight. […] Reduce and manage stress.

• #8 Atrial Flutter

  https://healthelibrary.stillwater-medical.org/Library/Wellness/Prevention/134,229

  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.

• #9 Atrial Flutter: Symptoms & Causes | NewYork-Presbyterian

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

  To prevent atrial flutter, take care of the health problems that increase your risk. Following basic guidelines for good health can help too. […] Maintain a healthy weight […] Avoid alcohol […] Don’t smoke […] Keep high blood pressure controlled […] Manage diabetes […] Eat a healthy diet with whole grains, fruits, and vegetables […] Get regular exercise.

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

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

  While atrial flutter cannot be entirely prevented, adopting a heart-healthy lifestyle can significantly mitigate risks. Consider the following recommendations: […] Avoid Smoking: Smoking cessation is crucial for heart health. […] Eat Nutritiously: Focus on a diet rich in fruits, vegetables, and whole grains while reducing salt and saturated fats. […] Engage in Regular Exercise: Aim for at least 30 minutes of physical activity most days. […] Maintain a Healthy Weight: This can help reduce strain on the heart. […] Limit Caffeine and Alcohol: Reducing these substances may help regulate heart rhythm. […] Manage Stress: Practice stress-reducing techniques such as mindfulness or meditation. […] Control Chronic Conditions: Effectively manage blood pressure, cholesterol levels, and diabetes. […] Prioritize Sleep: Aim for 7 to 9 hours of restful sleep each night.

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

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

  Effective prevention and management of potential causes – eg, hypertension, obesity, excessive alcohol intake, hyperthyroidism and obstructive sleep apnoea. […] 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. […] Adequate anticoagulation has been shown to decrease thromboembolic complications in patients with chronic atrial flutter and in patients undergoing cardioversion. […] Long-term anticoagulation is therefore advised for patients with persistent or paroxysmal atrial flutter where stroke risk is considered significant when balanced against bleeding risk as per the details in the Atrial Fibrillation article. […] After successful catheter ablation, if sinus rhythm is still present, NICE guidance suggests anticoagulation should be continued indefinitely. […] Cardioversion of atrial flutter presents similar risks to cardioversion of atrial fibrillation and therefore requires similar anticoagulation.

• #12 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. […] Prevention of thromboembolic complications: Adequate anticoagulation, as recommended by the American College of Chest Physicians, has been shown to decrease thromboembolic complications in patients with chronic atrial flutter and in patients undergoing cardioversion. […] Prevention of recurrent episodes or reduction in their frequency or duration: In general, the use of antiarrhythmic drugs in atrial flutter is similar to that in atrial fibrillation.

• #13 Atrial Flutter – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/specific-cardiac-arrhythmias/atrial-flutter

  Atrial flutter is a rapid regular atrial rhythm due to an atrial macroreentrant circuit. […] Treatment involves rate control with medication, prevention of thromboembolism with anticoagulants, and often conversion to sinus rhythm with medication, cardioversion, or atrial flutter substrate ablation. […] Accordingly, guidelines for anticoagulation make no distinction between patients with atrial flutter and those with atrial fibrillation. […] Treatment of atrial flutter focuses on ventricular rate control, rhythm control, and prevention of thromboembolism. […] Anticoagulation, as in atrial fibrillation, is necessary before cardioversion. […] 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). […] Long-term oral anticoagulation to prevent stroke is required for patients with chronic or recurrent atrial flutter. […] Recurrent episodes are prevented with class Ia, Ic, or III antiarrhythmic medications along with AV nodal suppression or, more effectively, by cavotricuspid isthmus ablation.

• #14 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. […] Avoiding these triggering circumstances might help in preventing future attacks. […] Oral dofetilide has 73% efficacy for the maintenance of sinus rhythm at 1 year, while oral flecainide has 50% long-term efficacy. […] Anticoagulant therapy in atrial flutter The risk of embolisation during cardioversion for atrial flutter ranges between 1,7 7,0%, the mean was 2,2%. […] Thus, the guidelines for anticoagulation in atrial flutter should be the same as for atrial fibrillation. […] Recurrent atrial flutter or even the first episode in high-risk patients with structural heart disease is indicated for long-term oral anticoagulation.

• #15 Pharmacologic prophylaxis for atrial fibrillation following cardiac surgery: a systematic review | Journal of Cardiothoracic Surgery | Full Text

  https://cardiothoracicsurgery.biomedcentral.com/articles/10.1186/1749-8090-5-121

  Atrial Fibrillation (AF) is the most common arrhythmia occurring after cardiac surgery. Effective treatment for prophylaxis of postoperative AF is vital as reduces hospitalization and overall morbidity. Beta – blockers, have been proved to prevent effectively atrial fibrillation following cardiac surgery and should be routinely used if there are no contraindications. Sotalol may be more effective than standard b-blockers for the prevention of AF without causing an excess of side effects. Amiodarone is useful when beta-blocker therapy is not possible or as additional prophylaxis in high risk patients. […] In conclusion, b-blockers should routinely be used as first choice for the prophylaxis of AF in all patients undergoing cardiac surgery, unless otherwise contraindicated (Grade A recommendation based on level 1a studies). Sotalol may be more effective than standard b-blockers for the prevention of AF without causing an excess of side effects (Grade A recommendation based on level 1b studies). Amiodarone should be used for prophylaxis of AF in all patients undergoing cardiac surgery in which b-blocker therapy is not possible (Grade A recommendation based on level 1a and1b studies). In high-risk patients receiving b-blocker therapy for prophylaxis of AF, amiodarone may also be used as additional prophylaxis with an acceptably low incidence of complications.

• #16 Amiodarone vs. sotalol as prophylaxis against atrial fibrillation/flutter after heart surgery: a meta-analysis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/11948054/

  Both amiodarone and sotalol were more effective than placebo treatment in reducing the incidence of postoperative AFF. […] This data would suggest that either drug could be used in a prophylactic regimen to reduce the incidence of AFF following heart surgery.

• #17 Atrial Flutter Treatment & Management: Approach Considerations, Ventricular Rate Control, Electrical Cardioversion

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

  Prevention of thromboembolic complications is crucial for patients with atrial flutter. Adequate anticoagulation has been shown to decrease these complications in patients with chronic atrial flutter and in patients undergoing cardioversion. […] Patients with atrial flutter and episodes of atrial fibrillation are at higher risk for thromboembolic events; however, determining whether episodes of atrial fibrillation are associated with episodes of atrial flutter is difficult. […] The CHA2DS2-VASc score has been shown to perform well at predicting whether a patient is at high or low risk for thromboembolism. […] Postcardioversion thromboembolic events can complicate as many as 7.3% of procedures in patients who are not anticoagulated. […] Anticoagulation for at least 30 days is advocated after ablation of an atrial flutter persisting for more than 2 days.

• #18 Atrial flutter: Risk of thromboembolism and role of anticoagulation – UpToDate

  https://www.uptodate.com/contents/embolic-risk-and-the-role-of-anticoagulation-in-atrial-flutter

  Anticoagulation to reduce the risk of embolic stroke and other thromboembolic events is a cornerstone of management for patients with atrial flutter (AFL). […] Our approach to anticoagulation for patients with AFL is described here.

• #19 Atrial fibrillation: an update on management – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/atrial-fibrillation-an-update-on-management.html

  Anticoagulation reduces the relative risk of stroke by around 70% in patients with atrial fibrillation. The options include warfarin or direct oral anticoagulant drugs such as factor Xa inhibitors apixaban and rivaroxaban and the direct thrombin inhibitor dabigatran. Aspirin is no longer recommended as an alternative. […] Direct oral anticoagulants are recommended as first-line therapy over warfarin in patients with nonvalvular atrial fibrillation, provided there are no absolute contraindications to their use. […] Oral anticoagulation therapy to prevent stroke and systemic embolism is recommended in patients with non-valvular atrial fibrillation whose CHA2DS2-VA score is 2 (high quality of evidence), unless there are contraindications to anticoagulation, and should be considered strongly if CHA2DS2-VA score is 1 (moderate quality of evidence).

• #20 Apixaban (Eliquis) for Stroke Prevention in Atrial Fibrillation | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0415/p672.html

  Apixaban (Eliquis) is the third new oral anticoagulant recently labeled to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. […] Discontinuing apixaban therapy places patients at a greater risk of thrombotic events. Unless they are discontinuing treatment because of serious bleeding, patients should be prescribed an alternative anticoagulant to prevent an increased risk of stroke. […] Apixaban is at least as effective as aspirin or warfarin for preventing strokes in high-risk patients with nonvalvular atrial fibrillation, especially those who cannot or will not take warfarin.

• #21 Atrial flutter: Maintenance of sinus rhythm – UpToDate

  https://www.uptodate.com/contents/atrial-flutter-maintenance-of-sinus-rhythm

  Atrial flutter is a relatively common supraventricular arrhythmia that can impact quality of life and cause stroke or systemic embolization. Restoration and maintenance of sinus rhythm improves symptoms and decreases the risk of embolization if atrial flutter recurrence does not occur. […] We attempt to keep most patients with recurrent atrial flutter in sinus rhythm to decrease symptoms, unlike atrial fibrillation (AF), in which rhythm control and rate control are reasonable strategies. In addition, the long-term maintenance of sinus rhythm may decrease the risk of stroke. Rhythm control with either radiofrequency (RF) catheter ablation or antiarrhythmic drug therapy is necessary; in most cases, RF catheter ablation is preferred because of the high rate of success and low rate of complications. […] In addition, episodes will often be recurrent unless a reversible cause is present.

• #22 Atrial Flutter: an Update – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-atrial-flutter-an-update-articulo-13092250

  Treatment should be via catheter ablation, which prevents recurrence in more than 90% of cases in the long term. […] Following ablation the administration of antiarrhythmic agents is stopped, except in patients who developed flutter during pharmacologically treated fibrillation, in which case this must be continued permanently. […] Ablation can cure flutter, but clinical assistance should not stop here. A detailed history can reveal the presence of chronic bronchopneumopathy, sleep apnea, hypertension, obesity or other processes whose treatment could help stop the underlying arrhythmogenic process.

• #23 Atrial Flutter | LifeBridge Health

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

  Treatment for atrial flutter is similar to atrial fibrillation. Physicians typically prescribe blood thinning medications for stroke prevention, as well as drugs to slow the heart rate during the flutter or prevent the arrhythmia altogether. These therapies are only suppressive. […] At the Ben and Zelda Cohen Heart Rhythm Center, we focus on catheter ablation, a curative therapy that renders medications unnecessary. The procedure is a same-day surgery with limited recovery time.

• #24 Revisiting an Underrecognized Strategy for Rhythm Management: Hybrid Therapy for Patients who Convert from Atrial Fibrillation to Flutter on Antiarrhythmic Drugs

  https://www.innovationsincrm.com/cardiac-rhythm-management/articles-2019/october/1479-revisiting-an-underrecognized-strategy-for-rhythm-management

  Atrial fibrillation (AF) is often treated with antiarrhythmic drugs (AADs) or catheter ablation. In a unique subset of patients, AF can convert to atrial flutter (AFL) after the initiation of an AAD. It has previously been shown that, in this subset of patients, cavotricuspid isthmus (CTI) ablation followed by the continuation of the AAD regimen has an unusually high rate of successfully maintaining sinus rhythm. This is an underrecognized approach toward rhythm management in such patients. […] This strategy, however, is underrecognized in current clinical practice, and no large prospective trials of this method of treatment exist at this time. Nevertheless, we suggest that consideration of this approach for treating AF, particularly in patients with new-onset or paroxysmal AF, should be given as long as there are no contraindications to using a class Ic antiarrhythmic in a particular case.

• #25 Revisiting an Underrecognized Strategy for Rhythm Management: Hybrid Therapy for Patients who Convert from Atrial Fibrillation to Flutter on Antiarrhythmic Drugs

  https://www.innovationsincrm.com/cardiac-rhythm-management/articles-2019/october/1479-revisiting-an-underrecognized-strategy-for-rhythm-management

  A hybrid approach to the treatment of AF has been suggested that involves CTI ablation and the maintenance of the antiarrhythmic medication for patients who initially convert from AF to typical AFL. This strategy has been shown to have a high success rate in limited studies. The reason for this high efficacy is unknown. We suggest that conversion from AF to AFL with class IC antiarrhythmics selects for a subset of the population in whom these medications are highly effective.

• #26 HIE Multimedia – Atrial fibrillation and atrial flutter

  https://sbrmc.adam.com/content.aspx?productid=117&pid=1&gid=000184

  Talk to your provider about steps to treat conditions that cause atrial fibrillation and flutter. Avoid binge drinking. […] People with AFib will most often need to take blood thinner medicines. These medicines are used to reduce the risk of developing a blood clot that travels in the body (and that can cause a stroke, for example). The irregular heart rhythm that occurs with AFib makes blood clots more likely to form. […] Another stroke prevention option for people who cannot safely take these medicines is the Watchman Device, which has recently been approved by the FDA. This is a small basket-shaped implant that is placed inside the heart to block off the area of the heart where most of the clots form. This limits clots from forming. […] Your provider will consider your age and other medical problems when deciding which stroke prevention methods are best for you.

• #27 Atrial fibrillation: an update on management – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/atrial-fibrillation-an-update-on-management.html

  The expert consensus is that patients with concurrent atrial fibrillation and ischaemic heart disease undergoing percutaneous coronary intervention should receive triple therapy with aspirin, clopidogrel and anticoagulation for as short a time as possible. […] Percutaneous left atrial appendage occlusion may be considered as an option in patients with atrial fibrillation at increased risk of stroke who have contraindications to long-term anticoagulation.

• #28 Atrial Flutter: an Update – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-atrial-flutter-an-update-articulo-13092250

  Invasive electrophysiologic studies have changed the clinical outlook for patients with atrial flutter. Recognition of the reentrant circuit responsible for typical atrial flutter has led to the development of catheter ablation techniques that can prevent recurrence in 90% of cases. […] Primary prevention and preventing the development of atrial fibrillation after ablation remain outstanding clinical challenges. […] Despite the success of ablation, long-term prognosis is frequently overshadowed by the appearance of atrial fibrillation, which suggests that flutter and fibrillation share a common arrhythmogenic origin that is not modified by cavotricuspid isthmus ablation. […] The incidence of recurrence of flutter after cardioversion could be lower than in fibrillation which means that, in the event that the arrhythmia is well-tolerated, a conservative strategy can be followed of clinical observation after the first episode has been cardioverted.

• #29 Prevention of Atrial Fibrillation After Atrial Flutter Ablation With Ramipril (from the PREFACE Study) – Inserm – Institut national de la santé et de la recherche médicale

  https://inserm.hal.science/hal-03414194/

  The clinical efficacy of the inhibitors of the renin-angiotensin-aldosterone system (RAAS) as an upstream therapy for atrial fibrillation (AF) prevention is controversial. No study has itemized so far the role of RAAS inhibitors in AF prevention after atrial flutter (AFL) ablation. This trial aims to investigate the effect of ramipril compared with placebo on AF occurrence in patients hospitalized for AFL ablation without structural heart disease. […] In conclusion, RAAS inhibition using ramipril does not reduce AF occurrence in patients facing AFL ablation during the 1-year follow-up.

• #30 Risk of Atrial Fibrillation after Ablation of Cavotricuspid Isthmus-Dependent Atrial Flutter: Is Combined Ablation of Atrial Fibrillation Worthwhile? – ABC Cardiol

  https://abccardiol.org/en/article/risk-of-atrial-fibrillation-after-ablation-of-cavotricuspid-isthmus-dependent-atrial-flutter-is-combined-ablation-of-atrial-fibrillation-worthwhile/

  Isabella Bianco ORCID logo , Gabriel Odozynski da Silva, Alexander Romeno Janner Dal Forno, Helcio Garcia Nascimento, Andrei Lewandowski, Elayne Pereira, Andr dAvila ORCID logo […] Simultaneous ablation of atrial fibrillation (AF) and cavotricuspid isthmus (CTI)-dependent atrial flutter can be performed when both arrythmias had been recorded before the procedure. However, the best approach has not been defined in case of patients referred for ablation with CTI-dependent atrial flutter, without history of AF. […] To assess the prevalence and to identify predictors of the first episode of AF after ablation of CTI-dependent atrial flutter in patients without history of AF. […] Although ablation of CTI-dependent atrial flutter is a safe and effective procedure, 50% of the patients developed AF after the procedure. However, the role of combined ablation (CTI-dependent atrial flutter plus AF) aiming at preventing AF is still uncertain. […] Keywords: Arial Fibrillation/prevention; Arrhythmias, Cardiac; Atrial Flutter; Conduction; Isthmus Cavo-Tricuspid; Radiofrequency Ablation

• #31 ATRIAL FLUTTER IN INFANCY: NO NEED FOR CHRONIC PROPHYLAXIS | Pediatric Research

  https://www.nature.com/articles/pr1987255

  Many authorities recommend digoxin for one year for atrial flutter (AT.FL) in infants with normal structural hearts. […] We conclude that infants with atrial flutter alone, following cardioversion, do not require chronic prophylaxis.

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