Atrial Flutter

Atrial flutter is a macroreentrant circuit in the right atrium resulting in high atrial rates of 250-350 beats per minute and a variable ventricular response. Unlike chaotic atrial fibrillation, it produces organised "sawtooth" flutter waves on the ECG, usually seen in leads II, III, and AVF.

Common symptoms include palpitations, dizziness, shortness of breath, weariness, and chest tightness; other cases are asymptomatic. Risk factors include hypertension, heart failure, valve disease, thyroid illness, and postoperative cardiac surgery. If not treated, it causes blood stasis, increasing the risk of thromboembolism and stroke.

Diagnosis is made by a 12-lead ECG revealing flutter waves and narrow QRS complexes; Holter monitoring or event recorders are useful for paroxysmal cases. Rate control: Beta blockers or calcium channel blockers Rhythm control: Antiarrhythmics such as flecainide

Catheter ablation of the cavotricuspid isthmus is >90% successful for normal flutter. Unstable patients with prior anticoagulation often receive electrical cardioversion to re-establish normal sinus rhythm. Anticoagulants such as DOACs prevent clots as per the CHA?DS?-VASc score.

Lifestyle approaches to prevention include minimising alcohol and caffeine and managing comorbidities. Early management improves prognosis in this reversible arrhythmia.