Atrial Flutter | Western Sydney University

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

120

Pages:

4
Author:

Mariam A. A.

Atrial flutter If diagnosis is unclear -> perform a vagal manoeuvre Helps differentiate it from atrial fibrillation Electrical cardioversion Hemodynamically unstable patients or less than 48 hours durnation If stable or duration more than 48 hours: BBs, CHB e.g. diltiazem or digoxin Anticoagulation (know indications) Atrial Flutter Presentations Palpitations Fatigue or light-headedness JV pulsations. With rapid flutter or cannon waves Chest pain Hypotension Embolic events MI Risk factors Increasing age Valvular dysfunction Atrial septal defects Atrial dilation Heart failure Hyperthyroidism COPD Asthma Pneumonia Surgical or post ablation scaring of atria Investigations ECG FBC TFTs -> to rule out thyroid disease Renal function and electrolytes CXR TTE: evaluate atrial size, ventricular function and assess for valvular and pericardial disease Management Haemodynamically unstable patients: E.g. features of shock 1 st line: emergency electrical cardioversion May consider pre-cardioversion anticoagulation Should not delay cardioversion Parenteral Unfractionated heparin or LMWH + supportive care + long term anticoagulation therapy For patients who are undergoing cardioversion or have concomitant AFiB Calculate stroke risk using CHA(2)DS(2)-VASc If anticoagulation is considered -> assess bleeding risk If suitable -> use DOACs Supportive care includes giving oxygen and continuous monitoring of ECG, oxygen and blood pressure Haemodynamically stable: 1 st line Rate control But usually ineffective at rate control -> so aim is to restore sinus rhythm with these drugs ? AV node blocking medication: BBs or NDCCBs NDCCBs contradicted if patient has HoTN or HFrEF BBs contradicted if have decompensated HF Digoxin may also be considered If also have a pre-exiting WPW -> do not use rate control meds Consider initial anticoagulation Unfractionated heparin or LMWH Continue until full assessment Treat underlying cause Long term anticoagulation strategy Assess for risk of stroke If suitable -> use DOACs e.g. apixaban (1 st line) Long term rhythm control strategy transoesophageal-guided or conventional cardioversion Recurrent atrial flutter or failure of elective cardioversion 1 st line: catheter ablation + long term anticoagulation If refractory to medical therapy or medical therapy is contradicted Assess for stroke risk If anticoagulation is suitable -> DOACs 2 nd line: long term rate control + long term anticoagulation + consider long term antiarrhythmic Consider antiarrhythmic if AF persists despite rate control Use amiodarone if patient has heart failure or structural heart disease Do not give class 1c Without co-prescribing an atrioventricular (AV) nodal blocking drug because of the risk of slowing of the atrial rate, which may result in 1:1 AV conduction and a potentially life-threatening ventricular rate