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Atrial flutter

Last reviewed: 12 Sep 2025
Last updated: 10 Dec 2024

Summary

Definition

History and exam

Key diagnostic factors

  • worsening heart failure or pulmonary symptoms
  • jugular venous pulsations with rapid flutter waves
Full details

Other diagnostic factors

  • palpitations
  • fatigue or lightheadedness
  • chest pain
  • dyspnea
  • syncope
  • hypotension
  • embolic events
Full details

Risk factors

  • increasing age
  • valvular dysfunction
  • atrial septal defects
  • atrial dilation
  • recent cardiac or thoracic procedures
  • surgical or postablation scarring of atria
  • heart failure
  • hyperthyroidism
  • COPD
  • asthma
  • pneumonia
  • antiarrhythmic drugs for atrial fibrillation
  • diabetes
  • digitalis use
  • male sex
  • congenital or lone atrial flutter
Full details

Diagnostic tests

1st tests to order

  • ECG
  • thyroid function tests
  • serum electrolytes
Full details

Tests to avoid

  • imaging stress tests
  • coronary CT angiography
Full details

Tests to consider

  • pulmonary function tests
  • CXR
  • digitalis level
  • cardiac enzymes
  • spiral CT with pulmonary embolism protocol
  • transthoracic echocardiogram
  • atrial electrogram recording
  • electrophysiologic studies
Full details

Treatment algorithm

INITIAL

hemodynamically unstable

ACUTE

hemodynamically stable

ONGOING

recurrent atrial flutter or failure of elective cardioversion

Contributors

Authors

Katherine C. Wu, MD, FACC

Associate Professor of Medicine

Johns Hopkins University

School of Medicine

Baltimore

MD

Disclosures

KCW declares that she has no competing interests.

Peer reviewers

Richard C. Wu, MD

Associate Professor of Medicine

Director

Cardiac Electrophysiology Laboratory

UT Southwestern Medical Center

University Hospital

St. Paul

Dallas

TX

გაფრთხილება:

RCW declares that he has no competing interests.

Reginald Ho, MD

Clinical Assistant Professor

Department of Medicine

Thomas Jefferson University Hospital

Philadelphia

PA

გაფრთხილება:

RH declares that he has no competing interests.

George Juang, MD, FACC

Director of Electrophysiology

Long Island Arrhythmia Center

Mineola

NY

გაფრთხილება:

GJ declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

წყაროები

ჩვენი მტკიცებულებებისა და სარედაქციო ჯგუფები თანამშრომლობენ საერთაშორისო ექსპერტებსა და რეცენზენტებთან, რათა უზრუნველვყოთ თქვენი წვდომა კლინიკურად ყველაზე მნიშვნელოვან ინფორმაციაზე.

ძირითადი სტატიები

Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia. J Am Coll Cardiol. 2016 Apr 5;67(13):e27-115.სრული ტექსტი  აბსტრაქტი

Hindricks G, Potpara T, Dagres N, et al. ESC Scientific Document Group. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021 Feb 1;42(5):373-498.სრული ტექსტი  აბსტრაქტი

Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2024 Jan 2;149(1):e1-156.სრული ტექსტი  აბსტრაქტი

გამოყენებული სტატიები

ამ თემაში მოხსენიებული წყაროების სრული სია ხელმისაწვდომია მომხმარებლებისთვის, რომლებსაც აქვთ წვდომა BMJ Best Practice-ის ყველა ნაწილზე.
  • Atrial flutter images
  • დიფერენციული დიაგნოზები

    • Atrial fibrillation
    • Atrial tachycardia
    მეტი დიფერენციული დიაგნოზები
  • გაიდლაინები

    • 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines​
    • 2020 ESC guidelines for the diagnosis and management of atrial fibrillation
    მეტი გაიდლაინები
  • პაციენტის ბროშურები

    Atrial fibrillation: what is it?

    Atrial fibrillation: what are the treatment options?

    მეტი პაციენტის ბროშურები
  • კალკულატორები

    Atrial Fibrillation CHA(2)DS(2)-VASc Score for Stroke Risk

    HAS-BLED Bleeding Risk Score

    მეტი კალკულატორები
  • Videos

    Electrical (direct current) cardioversion animated demonstration

    მეტი ვიდეოები
  • padlock-lockedშედით სისტემაში ან გამოიწერეთ BMJ Best Practice

ამ მასალის გამოყენება ექვემდებარება ჩვენს განცხადებას