Atrial Flutter

AFLT occurs <1/10 as often as AFIB.

Usually occurs in elderly pts with structural heart disease (those with LV dysfunction, RV dysfunction, pulm vascular disease, RHD, or CHD).

Other risk factors include COPD, hypertension, obesity, and male sex.

Occurs with relative frequency after cardiac surgery (peaks on postop d 2 to 4) but seldom after noncardiac surgery.

Circulatory insufficiency or myocardial ischemia from extremes of heart rate, especially in pts with CHD

Increased risk of thromboembolism

Associated disease, especially adequacy of CV and pulm function

Heart rate-related: Hemodynamic instability, myocardial ischemia, Pulmonary edema, or heart failure

Thromboembolism-related: Stroke, MI, or bowel ischemia

Increased proarrhythmia risk with drugs for pharmacologic cardioversion

Mechanism is atrial macro-reentry; circuit is usually in the right atrium.

Type I or typical AFLT: Most common form is characterized by regular atrial rates of 240 to 340 bpm with fixed (often 2:1) AV conduction.

Type II or atypical AFLT: Less commonly presents with regular atrial rates of 340 to 450 bpm, with variable or fixed AV conduction that may result in irregular QRS complex and pulse; re-entry is usually around previous atrial scars.