From the Guidelines
A complete workup for atrial flutter should include a thorough physical examination, medical history review, electrocardiogram (ECG), blood tests, chest X-ray, echocardiogram, and possibly a Holter monitor or event recorder, as well as consideration of catheter ablation as a treatment option, particularly for symptomatic or refractory cases, as recommended by the 2015 ACC/AHA/HRS guideline 1.
Diagnostic Tests
The diagnostic workup for atrial flutter involves several key tests:
- Electrocardiogram (ECG) to confirm the diagnosis by identifying the characteristic sawtooth pattern of atrial flutter waves.
- Blood tests to evaluate thyroid function, electrolyte levels, and complete blood count.
- Chest X-ray to assess heart size and check for lung disease.
- Echocardiogram to evaluate heart structure and function.
- Holter monitor or event recorder for continuous heart rhythm monitoring over 24-48 hours or longer.
Treatment Considerations
Treatment decisions are guided by the results of these diagnostic tests and may include:
- Rate control medications, such as beta blockers, diltiazem, or verapamil, as recommended for patients with hemodynamically tolerated atrial flutter 1.
- Rhythm control strategies, which may involve catheter ablation, particularly for patients with symptomatic or refractory atrial flutter 1.
- Anticoagulation therapy to reduce stroke risk, especially in patients with atrial flutter who have additional stroke risk factors.
- Catheter ablation, which is considered useful for patients with atrial flutter that is either symptomatic or refractory to pharmacological rate control, and is often preferred over long-term pharmacological therapy 1.
Special Considerations
In certain cases, additional tests or considerations may be necessary, such as:
- Transesophageal echocardiography to check for blood clots before cardioversion treatment.
- Exercise stress test to evaluate how the heart responds to physical activity.
- Detailed activation and entrainment mapping of the tachycardia for patients undergoing catheter ablation for non–CTI-dependent atrial flutter 1.
From the Research
Diagnosis of Atrial Flutter
- Typical atrial flutter (AFL) is a common atrial arrhythmia that may cause significant symptoms and serious adverse effects 2
- The diagnosis of AFL involves understanding its electrophysiology and the techniques used for its diagnosis and management 2
Management of Atrial Flutter
- Radiofrequency catheter ablation has emerged as a safe and effective first-line treatment for typical AFL due to its well-defined anatomic and electrophysiological substrate, and the relative pharmacologic resistance of typical AFL 2
- The management of AFL may also involve preventing embolic stroke, myocardial ischemia and infarction, and rarely a tachycardia-induced cardiomyopathy as a result of rapid atrioventricular conduction 2
Complete Workup for Atrial Flutter
- A complete workup for AFL may include:
- Electrophysiological studies to understand the underlying mechanisms of the arrhythmia 2
- Techniques for diagnosing and managing AFL, including radiofrequency catheter ablation 2
- Evaluation for potential complications such as embolic stroke, myocardial ischemia and infarction, and tachycardia-induced cardiomyopathy 2