From the Guidelines
Atrial flutter is a cardiac arrhythmia that requires prompt diagnosis and treatment to prevent complications, and according to the most recent guidelines 1, a 12-lead ECG is essential for diagnosis, which can show a characteristic "sawtooth" pattern in leads II, III, and aVF. The treatment of atrial flutter typically involves rate control with medications like beta-blockers or calcium channel blockers, along with anticoagulation therapy to prevent stroke 1. For rhythm control, cardioversion or pharmacological conversion with amiodarone may be attempted, and definitive treatment often requires catheter ablation, particularly for recurrent or symptomatic cases. Some key points to consider in the diagnosis and treatment of atrial flutter include:
- Atrial flutter is often a persistent rhythm that requires electrical cardioversion or radiofrequency catheter ablation for termination 1
- The ventricular response is typically regular but rapid, often at half the atrial rate (2:1 conduction) resulting in a ventricular rate around 150 beats per minute
- Atrial flutter occurs due to a reentry circuit, usually in the right atrium, causing the atria to contract rapidly and inefficiently, which can lead to symptoms like palpitations, shortness of breath, fatigue, or dizziness
- Anticoagulation therapy is crucial to prevent stroke, and medications like apixaban or warfarin may be used 1
- Catheter ablation of the cavotricuspid isthmus is effective for prevention of recurrent atrial flutter, and may be considered for patients with recurrent or symptomatic cases 1.
From the FDA Drug Label
With atrial fibrillation, part of the heart does not beat the way it should. This can lead to the formation of blood clots, which can travel to the brain, causing a stroke, or to other parts of the body The answer to a flutter on EKG is related to atrial fibrillation, which is a type of irregular heart beat.
- Atrial fibrillation is a condition where the heart does not beat as it should, which can lead to the formation of blood clots.
- Rivaroxaban (XARELTO) is used to reduce the risk of stroke and blood clots in adults with atrial fibrillation that is not caused by a heart valve problem.
- However, a flutter on EKG is not directly addressed in the label, and it is not clear if rivaroxaban (XARELTO) is used to treat this specific condition. 2
From the Research
Atrial Flutter on EKG
- Atrial flutter is a common atrial arrhythmia that may cause significant symptoms and serious adverse effects, including embolic stroke, myocardial ischemia and infarction, and, rarely, a tachycardia-induced cardiomyopathy resulting from rapid atrioventricular conduction 3
- The management of atrial flutter can be challenging, especially in patients with acute underlying medical illnesses, as attempts to control rate or rhythm may not be beneficial and can even lead to adverse events 4
Diagnosis and Management
- Typical atrial flutter can be diagnosed using electrocardiogram (ECG) and managed using various techniques, including radiofrequency catheter ablation, which has emerged as a safe and effective first-line treatment since its first description in 1992 3
- The success rates of rate or rhythm control attempts in patients with complex atrial fibrillation or flutter appear to be low, with only 19.1% of patients successfully rate controlled and 13.3% successfully rhythm controlled 4
Adverse Events
- Attempts at rate and rhythm control in patients with complex atrial fibrillation or flutter are associated with a nearly 6-fold higher adverse event rate than that for patients who are not managed with rate or rhythm control 4
- The adverse events associated with rate or rhythm control attempts include a risk difference of 33.6% and a relative risk of 5.7, highlighting the need for careful consideration of treatment options in these patients 4