Conventional nonsurgical therapies Electrical cardioversion – cardiology procedure to restore sinus rhythm (regular heart rhythm) in the presence of a cardiac arrhythmia (as emergency therapy; note: guideline-compliant thromboembolism prophylaxis). Surgical therapy Catheter ablation of the cavotricuspid isthmus (as permanent therapy) – therapeutic cardiology procedure to restore sinus rhythm (regular heart rhythm) in an existing cardiac … Atrial Flutter: Therapy
Medical history (history of illness) represents an important component in the diagnosis of atrial flutter. Family history Do you have relatives who suffer from cardiac arrhythmias? Social history Current medical history/systemic history (somatic and psychological complaints). How long have the complaints existed? What symptoms do you notice? Dizziness?* Palpitations (heart palpitations)?* Shortness of breath?* Unconsciousness … Atrial Flutter: Medical History
Cardiovascular System (I00-I99). Atrioventricular re-entrant tachycardia (AVRT) – belongs to the paroxysmal supraventricular tachycardias and leads to typical seizure-like episodes with tachycardia (heartbeat too fast: > 100 beats per minute), dizziness, and possibly signs of acute heart failure (cardiac insufficiency) Extrasystoles (heart stutter) – heartbeat that occurs outside the physiological heart rhythm. Kammerflatternv – life-threatening … Atrial Flutter: Or something else? Differential Diagnosis
2nd order laboratory parameters – depending on the results of the medical history, physical examination, etc. – for differential diagnostic clarification Small blood count Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate). Electrolytes – potassium, magnesium Thyroid parameters – TSH Highly sensitive cardiac troponin T (hs-cTnT) or troponin I (hs-cTnI) – to … Atrial Flutter: Test and Diagnosis
Therapy goals Restoration of normal sinus rhythm Prevention of apoplexy (stroke). Therapy recommendations Therapy of atrial flutter with antiarrhythmic drugs (drugs that act against cardiac arrhythmias) is performed only when electrical cardioversion (therapeutic procedure in cardiology to restore sinus rhythm (regular heart rhythm) in an existing arrhythmia) is not available or as an experiment in … Atrial Flutter: Drug Therapy
Obligatory medical device diagnostics. Electrocardiogram (ECG; recording of the electrical activity of the heart muscle). [Strictly regular atrial actions: regular, sawtooth P waves with a frequency of 250-400/min. Narrow QRS complexes AV nodal block and conduction in a 4:1 or 2:1 ratio, rarely alternating. Atrial flutter with regular AV conduction (usually 2:1): narrow ventricular complex … Atrial Flutter: Diagnostic Tests
1st order Radiofrequency ablation (ablation therapy) – method for permanent elimination of atrial flutter using a cardiac catheter. In this procedure, the excitation conduction pathway that leads to the arrhythmias is obliterated. Success rates for this procedure are 90-95%.
To prevent atrial flutter, attention must be paid to reducing individual risk factors. Behavioral risk factors Diet Opulent meal (sumptuous food) Micronutrient deficiency (vital substances) – see Prevention with micronutrients. Consumption of stimulants Alcohol (woman: > 15 g/day; man: > 20 g/day). Overweight (BMI ≥ 25; obesity). Medication Flecainide and propafenone (sodium channel blockers)-may induce … Atrial Flutter: Prevention
The following symptoms and complaints may indicate atrial flutter: Leading symptoms Palpitations (sensation of feeling the heartbeat). Chest pain Dyspnea (shortness of breath) Load reduction Syncope (momentary loss of consciousness) Associated symptoms Heart failure (cardiac insufficiency) Hypotension (low blood pressure) Note: Atrial flutter is often symptomatic as regular palpitations with preserved or reduced exercise capacity.
Pathogenesis (disease development) Atrial flutter is a cardiac arrhythmia with intraatrial excitation circling by macro-reentry (circling excitation) along the tricuspid annulus (heart valve between the right atrium and the right ventricle), resulting in a regular undulating (wave-like) rhythm. This shows a typical atrial rate of 240-350/min, often 2 to 1 crossed over i.e. ventricular rate … Atrial Flutter: Causes
The following are the most important diseases or complications that may be contributed to by atrial flutter: Cardiovascular system (I00-I99). Apoplexy (stroke) Intracardiac thrombus formation (formation of a blood clot in the heart; the risk is lower than in atrial fibrillation) Sudden cardiac death (PHT) Jumping to a different heart rhythm Psyche – nervous system … Atrial Flutter: Consequential Diseases
A comprehensive clinical examination is the basis for selecting further diagnostic steps: Assessment of consciousness using the Glasgow Coma Scale (GCS). General physical examination – including blood pressure, pulse, body weight, height; furthermore: Inspection (viewing). Skin and mucous membranes Neck vein congestion? Central cyanosis? (bluish discoloration of skin and central mucous membranes, e.g., tongue). Abdomen … Atrial Flutter: Examination
