Pseudo atrial flutter

Atrial flutter typically has a cycle length of 200 ms (300 cycles/min or 5 Hz); with 4:1 conduction through the AV node, this would lead to a ventricular rate of 75 bpm. We present a case of a patient with a Parkinsonian tremor at a frequency of 300 cycles/min that masqueraded as atrial flutter on the limb leads of a 12-lead ECG. He had presented with a respiratory tract infection and his bedside rhythm monitor appeared to show atrial flutter. This appeared consistent on a printed (lead II) rhythm strip. His intrinsic sinus rate was coincidentally 75 bpm, which added to the confusion in the initial assessment of his rhythm (mistaken to be atrial flutter with 4:1 AV conduction). Advice was sought regarding management of his atrial 'arrhythmia' and the appropriateness of anticoagulation and cardioversion. A 12-lead ECG was performed and assessment of this revealed normal sinus rhythm. He therefore avoided unnecessary therapy.     

Management of atrial flutter

Typical atrial flutter is a macroreentrant arrhythmia of the right atrium. The isthmus area between the tricuspid annulus, the inferior vena cava, and the ostium of the coronary sinus is a critical zone of the reentry circle. Atrial flutter has been treated with class I and III antiarrhytmic drugs to maintain sinus rhythm, with moderate success. Catheter ablation has been highly successful in treating atrial flutter. A contiguous line of bidirectional electrical block is created in the isthmus area between the tricuspid annulus and the inferior vena cava by application of radiofrequency energy. In patients with both atrial flutter and atrial fibrillation, ablation of the atrial flutter circuit may make the atrial fibrillation more easy to control. Quality of life assessments show improvement after ablation of atrial flutter. With a probability of success of 90%, a recurrence rate of 5% to 15%, and few complications, catheter ablation emerges as the best treatment of recurrent, symptomatic flutter.     

Sleep apnea does not predict atrial flutter recurrence after atrial flutter ablation

Purpose  

Sleep apnea (SA) has been associated with atrial fibrillation (AF) and has been found to be a predictor of AF recurrence after successful pulmonary vein isolation. No investigations have been carried out to determine the prevalence of SA in patients with typical atrial flutter (AFL) and the impact of SA on AFL recurrence after AFL ablation. Our aim is to determine if SA is a predictor of recurrence of AFL and/or atrial arrhythmias in patients who have undergone AFL ablation.     

Management of atrial flutter

Atrial flutter is a macroreentrant arrhythmia that is associated with cardiovascular and pulmonary disease. In the United States, 200,000 new cases of atrial flutter can be expected to develop every year with a male to female ratio of over 2:1. This arrhythmia is associated with atrial fibrillation in over half the cases. It is also associated with an increased risk of thromboembolic complications, but less than that is seen with atrial fibrillation. The most common form of atrial flutter involves a large reentrant circuit within the right atrium, encircling the tricuspid annulus. Other, less common forms of atrial flutter may involve other anatomic barriers, atriotomy scars, and infarcted areas of the atria. Treatment of atrial flutter often involves electrical cardioversion and/or antiarrhythmic medications. Type I and Type III antiarrhythmic drugs are often used to terminate or prevent recurrent episodes and Type II (beta-blockers) and Type IV (calcium channel blockers) can be used to control the ventricular rate during atrial flutter. However, antiarrhythmic drugs alone control atrial flutter in only 50% to 60% of patients. Since the early 1990s, radiofrequency catheter ablation has been used to interrupt the reentrant circuit and prevent recurrences of atrial flutter. Radiofrequency ablation is acutely successful in over 90% of cases and avoids the long-term toxicity seen with antiarrhythmic drugs. Advanced mapping techniques and newer methods of delivering the radiofrequency lesions are being used to delineate unusual forms of atrial flutter and to minimize fluoroscopic exposure during the procedure.     

Inapparent atrial flutter due to atrial dissociation

Percutaneous and surgical procedures intended to potentially cure atrial fibrillation require creating lines of conduction block in specific locations throughout the atrial chambers. In patients presenting with recurrent atrial fibrillation, repeat procedures are often performed, resulting in more extensive regions of conduction block and the potential for regions of dissociated atrial rhythms. The present case describes a patient post-multiple ablation procedures who presented with a symptomatic atrial arrhythmia, the mechanism of which was hidden by the presence of extensive atrial dissociation. Electrophysiologic study revealed the appropriate mechanism and a beneficial ablative procedure was then successfully accomplished.     

心房颤动与心房扑动的关系

心房颤动(atrial fibrillation，AF)是临床上最常见的持续性的心律失常。AF患者往往有心房扑动(atrial flutter，AFL)发作，而AFL患者也常伴有AF^[1-3]。在使用抗心律失常药物治疗过程中，AF可能变为AFL^[4-5]，或AFL蜕变为AF^[6-9]。这些现象提示二者在发生和维持机制上可能存在一些共性和相互关联。     

Prognostic differences between atrial fibrillation and atrial flutter

This report presents the outcome of a cohort of 94 patients with atrial fibrillation from the Canadian Registry of Atrial Fibrillation, in which we paid particular attention to the probability of stroke and death. We also evaluated warfarin use over time and compared left atrial dimensions in patients with atrial flutter with those with atrial fibrillation.