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Encyclopedia > Atrial flutter
Atrial flutter
Classification & external resources
ICD-10 I48.
ICD-9 427.32
DiseasesDB 1072
MedlinePlus 000184
eMedicine med/185 

Atrial flutter is an abnormal fast heart rhythm that occurs in the atria of the heart. This rhythm occurs most often in individuals with organic heart disease (ie: pericarditis, coronary artery disease, and cardiomyopathy). The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... In anatomy, the atrium (plural: atria) is the blood collection chamber of a heart. ... The heart and lungs, from an older edition of Grays Anatomy. ... Pericarditis is inflammation of the sac surrounding the heart, the pericardium. ... Coronary heart disease (CHD), also called coronary artery disease (CAD) and atherosclerotic heart disease, is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart). ...


Atrial flutter is typically not a stable rhythm, and frequently degenerates to atrial fibrillation. However, it may persist for months to years. Atrial fibrillation (AF or afib) is an abnormal heart rhythm (cardiac arrhythmia) which involves the two small, upper heart chambers (the atria). ...

Contents

Symptoms

While atrial flutter can sometimes go unnoticed, its onset is often marked by characteristic sensations of rapid regular thumping in the chest and palpitations. Such sensations usually last until the episode resolves, or until the heart rate is controlled. This article does not cite any references or sources. ...


Atrial flutter is usually well tolerated initially (fast heart beat is for most people, just a normal response to exercise), however, people with other underlying heart disease or poor exercise tolerance may rapidly develop symptoms, which can include shortness of breath, chest pains, lightheadedness or dizziness, nausea and, in some patients, nervousness and feelings of impending doom.


Prolonged fast flutter may lead to decompensation and loss of normal heart function (heart failure). This may manifest as effort intolerance (exertional breathlessness), nocturnal breathlessness, or swelling of the legs or abdomen.


Mechanism of action

Atrial flutter is caused by a reentrant rhythm in either the right or left atrium. Typically initiated by a premature electrical impulse arising in the atria, atrial flutter is propogated due to differences in refractory periods of atrial tissue. This creates a loop of reentry moving around the atrium. Recent studies have shown that patients with typical atrial flutter demonstrate longer refractory periods in the lower right atrial tissue. Cardiac arrhythmia is a group of conditions in which the electrical activity of the heart is irregular or is faster or slower than normal. ...


Types of atrial flutter

There are two types of atrial flutter, known as type I and type II.1 Most individuals with atrial flutter will manifest only one of these types of atrial flutter. Rarely someone may manifest both types of flutter; however, they can only manifest one type at a time.


Type I flutter

Type I atrial flutter, counterclockwise rotation with 4:1 AV nodal block.
Type I atrial flutter, counterclockwise rotation with 4:1 AV nodal block.

Type I atrial flutter, also known as common atrial flutter or typical atrial flutter, has an atrial rate of 240 to 350 beats/minute. However, this rate may be slowed by antiarrhythmic agents. Image File history File links No higher resolution available. ... Image File history File links No higher resolution available. ... The atrioventricular node (abbreviated AV node) is the tissue between the atria and the ventricles of the heart, which conducts the normal electrical impulse from the atria to the ventricles. ... Antiarrhythmic agents are a group of pharmaceuticals that are used to suppress fast rhythms of the heart (cardiac arrhythmias), such as atrial fibrillation, atrial flutter, ventricular tachycardia, and ventricular fibrillation. ...


Type I flutter can be entrained by rapid atrial beating. This means that the re-entrant rhythm of the flutter can be broken if a stimulus enters the re-entrant cycle at just the right point, breaking the cycle and thereby terminating the atrial flutter. While this can be performed with a pacemaker, it is performed almost exclusively in the electrophysiology lab by pacing the atrium at a rate just above the rate of the atrial flutter. While entrainment may break atrial flutter and cause the individual to revert to a normal sinus rhythm, the rapid atrial pacing may cause the individual to go into atrial fibrillation. Type I atrial flutter is increasingly easy to cure in the electrophysiology lab due to its dependence on a fixed anatomic structure known as the isthmus. The isthmus is a body of fibrous tissue that makes up a portion of the reentrant loop. Catheter ablation of the isthmus prevents reentry, and terminates atrial flutter if successful. A pacemaker A pacemaker (or artificial pacemaker, so as not to be confused with the hearts natural pacemaker) is a medical device designed to regulate the beating of the heart. ... Atrial fibrillation (AF or afib) is an abnormal heart rhythm (cardiac arrhythmia) which involves the two small, upper heart chambers (the atria). ...


Type I flutter has two subtypes, known as counterclockwise atrial flutter and clockwise atrial flutter.


Counterclockwise atrial flutter

Counterclockwise atrial flutter (known as cephalad-directed atrial flutter) is more commonly seen than clockwise atrial flutter. The flutter waves in this rhythm are inverted in II, III, and aVF.


Clockwise atrial flutter

Clockwise atrial flutter is less common than counterclockwise atrial flutter. The flutter waves are upright in II, III, and aVF in this rhythm.


Type II flutter

Type II flutter is faster than type I flutter, and usually is 340–430 beats/minute.


Unlike type I flutter, the rhythm of type II flutter cannot be entrained by rapid atrial pacing.


Complications

Clot formation

In atrial flutter, as in atrial fibrillation, there is no effective contraction of the atria. In individuals with structural heart disease, this causes stasis of blood in the atria. The stasis of blood leads to formation of thrombus material (clots) within the heart. In the left side of the heart, thrombus is most likely for form in the left atrial appendage. This is important because, since the left side of the heart supplies blood to the entire body, any thrombus material that dislodges from the left side of the heart can potentially embolize to the brain, causing a stroke. Of course, the thrombus material can also embolize to any other portion of the body. Atrial fibrillation (AF or afib) is an abnormal heart rhythm (cardiac arrhythmia) which involves the two small, upper heart chambers (the atria). ... In anatomy, the atrium (plural: atria) is the blood collection chamber of a heart. ... Blood clot diagram. ... In medicine, an embolism occurs when an object (the embolus, plural emboli) migrates from one part of the body (through circulation) and cause(s) a blockage (occlusion) of a blood vessel in another part of the body. ... Stroke (or cerebrovascular accident or CVA) is the clinical designation for a rapidly developing loss of brain function due to an interruption in the blood supply to all or part of the brain. ...


Sudden death

Sudden death is not directly associated with atrial flutter. However, in individuals with a pre-existing accessory conduction pathway, such as the bundle of Kent in Wolff-Parkinson-White syndrome, the accessory pathway may conduct activity from the atria to the ventricles much faster than the AV node. In this case, the atrial rate of 300 beats/minute will lead to a ventricular rate of 300 beats/minute. If the ventricles are unable to sustain such high ventricular rates, 1:1 flutter may degenerate into ventricular fibrillation, causing hemodynamic collapse and death. Bundle of Kent is an extra or accessory conduction pathway between the atria and ventricles in the heart. ... Wolff-Parkinson-White syndrome (WPW) is a syndrome of pre-excitation of the ventricles of the heart due to an accessory pathway known as the Bundle of Kent. ... Ventricular fibrillation (V-fib or VF) is a cardiac condition which consists of a lack of coordination of the contraction of the muscle tissue of the large chambers of the heart that eventually leads to the heart stopping altogether. ... This article or section does not adequately cite its references or sources. ...


Treatment

In general, atrial flutter should be treated the same as atrial fibrillation. Because both rhythms can lead to the formation of thrombus material in the atria, individuals with atrial flutter usually require some form of anticoagulation or anti-platelet agent. Additionally, a couple of treatment considerations exist that are particular to individuals with atrial flutter. Atrial fibrillation (AF or afib) is an abnormal heart rhythm (cardiac arrhythmia) which involves the two small, upper heart chambers (the atria). ... Blood clot diagram. ...


Ablation

Because of the reentrant nature of atrial flutter, it is possible to ablate the circuit that causes atrial flutter. This is done in the electrophysiology lab by causing a ridge of scar tissue that crosses the path of the circuit that causes atrial flutter. Ablation of the isthmus, as discussed above, is a common treatment for typical atrial flutter.


Rate control

Control of the ventricular rate in atrial flutter may be more difficult than if the individual was in atrial fibrillation. This is because of properties of the AV node. In atrial fibrillation, the AV node is typically bombarded with signals from the atria at rates in excess of 400 beats/minute. This causes a high degree of block within the AV node, with many signals partially penetrating the node and blocking at the lower levels of the AV node. This phenomenon is known as concealed conduction. The AV node has decremental properties, such that it will permit more electrical signals to pass through at lower frequences. Therefore, in atrial flutter, on the other hand, the AV node receives signals very rhythmically at a rate of about 300/minute compared to > 400/minute in fibrillation. Since the atrial flutter is an organized rhythm of the atria, the block at the AV node will be consistently at the same level, and paradoxically a higher number of impulses will get through per minute. The atrioventricular node (abbreviated AV node) is the tissue between the atria and the ventricles of the heart, which conducts the normal electrical impulse from the atria to the ventricles. ...


References

  1. Chou's Electrocardiography in Clinical Practice, Fifth Edition, Surawicz & Knilans, ISBN 0-7216-8697-4
  2. Electrophysiologic Testing, Richard N. Fogoros, Blackwell Science, ISBN 0-632-04325-3

External Links

See also


  Results from FactBites:
 
Atrial Flutter and Treatment (1067 words)
Atrial flutter may be a transitory acute disturbance in rhythm or it may be a chronic and recurrent disorder.
Because atrial flutter is characterized by a very small excitable gap difficult to penetrate within the limits of atrial refractoriness, it is not commonly possible to interrupt atrial flutter with the introduction of critically timed single atrial premature beats.
Atrial flutter is usually encountered in patients with severe mitral valve disease, those with thyrotoxicosis, those with primary myocardial disease, those with pericardial disease, in some patients with acute MIs, in those with chronic obstructive pulmonary disease and systemic arterial hypoxia, and with some frequency in patients after open-heart surgery.
Atrial flutter - Wikipedia, the free encyclopedia (1301 words)
Atrial flutter is a rhythmic, fast rhythm that occurs in the atria of the heart.
Atrial flutter is typically not a stable rhythm, and frequently degenerates to atrial fibrillation.
Atrial flutter is caused by a reentrant rhythm in either the right or left atrium.
  More results at FactBites »

 
 

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