The rhythm strip across the bottom is V1 (it is usually lead II) Narrow complex tachycardia at rate of 135. Notice there is a "P-wave" directly superimposed (on top of) the T-wave in V1. Notice there is a "P-wave" just before the QRS in V1 In these cases, they were misdiagnosed as sinus tachycardia (not PSVT): Here are a couple other cases of atrial flutter which were misdiagnosed. More cases of misdiagnosed atrial flutter This is primarily because patients with atrial flutter often alternate between fib and flutter, and produce thrombi during episodes of fibrillation. Similarly to atrial fibrillation, patients with atrial flutter do develop atrial thrombi, and thus cardioversion may involve a risk of thromboembolism if the onset of atrial flutter is not within 12-48 hours of ED presentation. Electrical works better (see article summary at bottom) but has a risk of thromboembolism: So atrial flutter must be treated with either:ġ) A longer acting AV nodal blocker, such as diltiazem infusion, to slow the ventricular response orĢ) Cardioversion, whether electrical or chemical. When the adenosine wears off, the impulse will continue to conduct through the AV node, still at a 2:1. The half-life of adenosine is about 10 seconds, and its effect will rapidly wear off (thankfully, otherwise this patient would be dependent on ventricular escape beats for perfusion!) Therefore adenosine will not interrupt the loop. So adenosine can help to diagnose atrial flutter, but it will not treat atrial flutter.Ītrial flutter does not use the AV node for part of its re-entrant loop, as does PSVT. This "reveals" the flutter waves, which of course continue.Īdenosine simply blocks the AV node so that there is no QRS to hide the flutter waves, and they become obvious. The AV node is blocked by adenosine and QRSs disappear. Thus, adenosine is often given.Īdenosine was given, during which this rhythm strip was recorded: The flutter rate is relatively fast at 334, such that the ventricular rate is 167 (one half the atrial rate).Īs easy as it may seem to make this diagnosis, it is often misdiagnosed as PSVT. In V1, there are upright waves that appear to be P-waves but are not: they are atrial waves and it is typical for atrial flutter waves to be upright in V1, whereas sinus P-waves are biphasic in V1. There are clear flutter waves in lead II across the bottom. It is atrial flutter with 2:1 conduction. The computer reads supraventricular tachycardia. If this happens, the procedure may be repeated or you and your health care provider might consider other treatments.A 40-something presented with palpitations and had a regular pulse at 170. Most people see improvements in their quality of life after this type of cardiac ablation, but there's a chance the atrial flutter may return. ResultsĪfter atrial flutter ablation, you'll need regular checkups to monitor your heart. Afterward, you'll be taken to a recovery area where care providers will closely monitor your condition.ĭepending on your condition, you may be allowed to go home the same day or you may spend a night in the hospital. The scarring helps block the electrical signals that are causing the atrial flutter.Ītrial flutter ablation typically takes two to three hours. Heat (radiofrequency energy) is applied to the target area, damaging the tissue and causing scarring. This information is used to determine the best place to apply the ablation treatment. Sensors on the tip of the catheter send electrical impulses and record the heart's electricity. The doctor inserts a long flexible tube (catheter) into the vein and carefully guides it into your heart. Once the sedative takes effect, a small area near a vein, usually in your groin, is numbed. You'll likely receive a medication to help you relax (sedative). What you can expectĪtrial flutter ablation is done in the hospital. Atrial flutter ablation may restore a typical heart rhythm, which may improve quality of life. Atrial flutter ablation is done to control the signs and symptoms associated with atrial flutter.
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