Atrial flutter

Atrial flutter. Atrial flutter is a tachyarrhythmia characterized by the rapid formation of regular impulses of atrial origin, produced by reentry at the level of the right atrium, with a frequency between 250 and 350 per minute. On the electrocardiogram it gives rise to a characteristic ” sawtooth ” record.

Table of Contents

Summary

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1 How is it produced?
2 Causes
3 Symptoms
4 Diagnosis
5 Treatment
6 Source

How is it produced?

Under normal conditions the heart contracts rhythmically and synchronously. This contraction is the result of an electrical impulse that is generated in the atrium, reaches the ventricle, and results in a heartbeat. In an arrhythmia, an alteration of this mechanism occurs that leads to the heart not contracting regularly, generating a rhythm disorder. The normal heart rate is between 50-100 beats per minute. When it is higher than 100 beats per minute, it is called tachyarrhythmia.

In the flutter the electrical impulse instead of continuing its usual path from the atrium to the ventricle follows a circuit around one of the heart valves (tricuspid valve) causing an irregular and fast rhythm that causes the ventricle not to contract efficiently.

The main complications of this arrhythmia include failure of the heart’s pump function, which prevents blood from being properly distributed throughout the body, and the appearance of thromboembolism. In the absence of a coordinated atrio-ventricular contraction, the blood can pool in the atrium and, when stagnant, lead to thrombi that can cause embolisms when they exit the bloodstream driven by the heart .

Causes

Acute phase of myocardial infarction.
Pulmonary embolism .
Acute myocarditis .
Postoperative thoracic surgery.
Mitral valve disease.
Hyperthyroidism
Atrial septal defect.
Hypertrophic cardiomyopathy .
Atrial dilation from any cause.

Symptoms

In some patients the flutter does not produce symptoms. When these appear the most frequent are palpitations. You may also feel shortness of breath or feeling short of breath and tiredness. Other more serious symptoms resulting from failure of the heart’s pump function or from the presence of underlying heart or lung disease include hypotension , chest pain, and syncope (sudden loss of level of consciousness).

Diagnosis

The basic diagnostic test to detect this type of arrhythmia is the electrocardiogram that allows recording the characteristic heart rate of the flutter with “sawtooth” morphology.

Other complementary tests may be requested to determine the cause of the arrhythmia, such as:

Analytical to rule out trigger diseases such as hyperthyroidism .
Echocardiogram. It allows to see if there are alterations in the structure and function of the heart.
Holter. Some patients have symptoms suggestive of arrhythmias, but when the EKG is performed it is normal. In these cases, to help identify the diagnosis of the arrhythmia that appears and disappears, an electrocardiogram record is made for 24 hours by means of a monitor that the patient must carry during that period of time.
Electrophysiological study. It allows obtaining a map of the heart’s electrical conduction system , to find out the type of arrhythmia and its possible origin.

Treatment

Treatment is aimed at controlling rhythm and heart rate as well as the appearance of complications associated with this type of arrhythmia (thromboembolism).

Radiofrequency ablation is a procedure that uses a catheter and a device to map the electrical conduction pathways of the heart. Using high-frequency electromagnetic waves, the conduction pathways responsible for the arrhythmia can be destroyed. It is considered one of the treatments of choice in this type of arrhythmia since in a large number of cases it can restore normal heart rhythm.
Antiarrhythmic drugs allow the control and treatment of most of the arrhythmias. There are numerous groups of drugs that act by different mechanisms, slowing down the heart rate and restoring the normal rhythm of the heart . They can be administered orally or intravenously and always under medical supervision and indication.
Cardioversion is a treatment used to restore sinus rhythm (normal rhythm) after applying an electrical shock to the chest or using drugs. It is usually used in emergency situations when the patient has severe symptoms due to arrhythmia.
Treatments aimed at reducing the complications of this arrhythmia: anticoagulant drugs.