Pharmacotherapy to revert flutter back to sinus rhythm is not very effective.įurthermore, antiarrhythmic treatments class I can slow down atrial rates and therefore prompt 1:1 atrioventricular conduction, causing very high ventricular rates (200 bpm or higher) and clinical manifestations similar to those of ventricular tachycardia. It is less common than typical atrial flutter and even though it is also caused by a macro-reentry mechanism, this is produced in different structures as those described in the typical atrial flutter.Ītypical atrial flutter have less clear causes, sometimes secondary to previous heart surgery or atrial ablation procedures.Įlectrocardiographically it is more difficult to classify since heart rate is more variable and “saw-tooth” waves are not clearly shown. Positive flutter waves in lead II Atypical Atrial Flutter Also, it usually causes undulations of the isoelectrical segments, acting as a diagnostic aid in high heart rates. It is usually visualised between the T wave and the following QRS complex. Its main feature is a slow descending start, followed by a fast descending phase turning into a fast rise, finishing above the isoelectric line while connecting with the beginning of the following wave (creating thus the “saw-teeth” shape) 3. It owns its name to its morphology in the EKG leads where it is predominantly negative. This wave is characteristic of the atrial flutter, especially recognisable in the typical atrial flutter (see below). As such, it can be mistaken for atrial fibrillation, but it is differentiated by the “saw-tooth” waves. In certain cases, it is arrhythmic and the conduction may be variable. The QRS complex is narrow, except with previous bundle branch blocks or aberrant conduction ( Ashman phenomenon). There are no existing P waves, although atrial waves with “saw-tooth” pattern are spotted with rates around 300 bpm. Atrial flutter is distinguishable on the electrocardiogram because it is a rhythmic tachycardia with heart rates that are divisors of 300 bpm, 150 bpm being the most frequent in untreated patients (AV conduction ratio 2:1).
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