ARRHYTHMIAS-ATRIAL FLUTTER

SUMMARY

1. Tachycardia with atrial rate is 200-350/min, forms a saw-tooth pattern on ECG.

2. There is large clockwise/counter-clockwise circus movement (conduction defect that permits a wave of excitation to propagate continuously within a closed circuit) within the RA.

3. assoc. with 2:1 AV block as the AV node is unable to conduce impulses greater than 230/min.

4. Ventricular rate can be slowed by vagal stimulation (valsalva manoeuvre, carotid sinus pressure).

5. Often triggered by IHD, myocarditis, valvular heart disease, post-rheumatic fever.

6. Tx: DC cardioversion if haemodynamic compromise, IV ibutilide, flecanide for non-emergent cardioversion, anticoagulation for stroke prevention. Radiofrequency ablation once stable.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].