Atrial flutter

Last reviewed: 18 Apr 2022
Last updated: 12 Feb 2020

Summary

Definition

History and exam

Key diagnostic factors

  • worsening heart failure or pulmonary symptoms
  • jugular venous pulsations with rapid flutter waves
More key diagnostic factors

Other diagnostic factors

  • palpitations
  • fatigue or lightheadedness
  • chest pain
  • dyspnea
  • syncope
  • hypotension
  • embolic events
Other diagnostic factors

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 gender
  • congenital or lone atrial flutter
More risk factors

Diagnostic investigations

1st investigations to order

  • ECG
  • thyroid function tests
  • serum electrolytes
More 1st investigations to order

Investigations to consider

  • pulmonary function tests
  • CXR
  • digitalis level
  • cardiac enzymes
  • spiral CT with pulmonary embolism protocol
  • transthoracic echocardiogram
  • atrial electrogram recording
  • electrophysiologic studies
More investigations to consider

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

Disclosures

RCW declares that he has no competing interests.

Reginald Ho, MD

Clinical Assistant Professor

Department of Medicine

Thomas Jefferson University Hospital

Philadelphia

PA

Disclosures

RH declares that he has no competing interests.

George Juang, MD, FACC

Director of Electrophysiology

Long Island Arrhythmia Center

Mineola

NY

Disclosures

GJ declares that he has no competing interests.

  • Atrial flutter images
  • Differentials

    • Atrial fibrillation
    • Atrial tachycardia
    More Differentials
  • Guidelines

    • 2019 ESC guidelines for the management of patients with supraventricular tachycardia
    • 2018 focused update of the Canadian Cardiovascular Society guidelines for the management of atrial fibrillation
    More Guidelines
  • Patient leaflets

    Atrial fibrillation: what is it?

    Atrial fibrillation: what treatments work?

    More Patient leaflets
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