![]() ![]() The signal then travels to the atrioventricular node, near the center of the heart, where it is slowed down briefly (or pauses) to allow the ventricles to fill with blood. This signal travels from the right atrium to the left atrium and tells both of these chambers to pump blood into the lower heart chambers (right and left ventricles). Normally, your heartbeat begins with an electrical signal that's sent out by the sinus node (or sinoatrial node), a group of cells located in the upper right heart chamber (right atrium). The condition is similar to atrial fibrillation (afib) - the most common type of arrhythmia (abnormal heartbeat) - and it can cause similar symptoms and complications.Ītrial flutter is much less common than afib, and people with atrial flutter can also have episodes of afib. Atypical atrial flutter originates from the left atrium or areas in the right atrium, such as surgical scars, and has a variable appearance on ECG in regards to the flutter waves.Atrial flutter is an abnormal, rapid heartbeat that produces a "sawtooth" pattern on an electrocardiogram.Ītrial flutter is a heart disorder in which the heart beats much faster than normal. This appears as positively-directed flutter waves in the inferior leads. ![]() This results in negatively-directed flutter waves in the inferior leads.Īt times, the direction of the circuit can reverse, causing clockwise atrial flutter from the same anatomical location. Typical atrial flutter rotates counterclockwise in direction, from a reentrant circuit around the tricuspid valve annulus and through the cavo-tricuspid isthmus. Also, atrial flutter can be described as “clockwise” or “counterclockwise” depending on the direction of the circuit. In this situation, giving adenosine will transiently slow the ventricular rate, unmasking the atrial flutter waves and allowing a more definitive diagnosis to be made.Ītrial flutter can described as “typical” (type I) or “atypical” (type II) based on the anatomic location from which it originates. When the heart rate is significantly elevated - that is, greater than 150 bpm - it is often difficult to determine atrial flutter from atrial fibrillation, atrial tachycardia or atrioventricular nodal reentrant tachycardia, or AVNRT. This results in the rhythm becoming “irregularly irregular.” There are only two other rhythms that are commonly irregularly irregular, including atrial fibrillation and multifocal atrial tachycardia, or MAT. ![]() In this situation, there may be three P waves to one QRS complex, then a quick change to two P waves to one QRS complex, and so on any combination of P waves to QRS complexes can occur. The regularity of the QRS complexes frequently present with atrial flutter helps to distinguish it from atrial fibrillation, though atrial flutter with variable conduction of the P waves can also occur. In this situation, the ventricular (QRS) rate will be exactly 150 bpm and regular.ĬLINICAL PEARL: A narrow complex tachycardia at a ventricular rate of exactly 150 bpm is very commonly atrial flutter. Typically, the atrial rate will be about 300 bpm, and only every other atrial depolarization will be conducted through the AV node. Just as in atrial fibrillation, not all of the P waves are able to conduct through the atrioventricular node, and thus the ventricular rate will not be as fast as the atrial rate. ![]()
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