Atrial Flutter

Question 1

What is the underlying cause of atrial flutter?

Answer 1

Abnormal electrical signals in the atria cause them to contract very rapidly (similar to AF but more organised).

Question 2

How does atrial flutter appear on ECG compared to atrial fibrillation?

Answer 2

Flutter waves (sawtooth pattern) instead of chaotic fibrillatory waves.

Question 3

What is the typical atrial rate in atrial flutter?

Answer 3

~300 bpm (but can vary depending on conduction ratio).

Question 4

Are P waves present in atrial flutter?

Answer 4

No distinct P waves – replaced by flutter (“F”) waves.

Question 5

How are flutter waves described on ECG?

Answer 5

Regular, sawtooth-shaped deflections best seen in leads II, III, aVF.

Question 6

How is the ventricular rhythm (R-R interval) in atrial flutter?

Answer 6

Can be regular or irregular, depending on AV conduction.

Question 7

Why can’t PR or QT interval be measured in atrial flutter?

Answer 7

No clear P waves or T waves to measure from.

Question 8

Name 3 common causes of atrial flutter.

Answer 8

1. Heart valve disease (esp. tricuspid or mitral)
2. Myocardial infarction
3. Overactive thyroid (hyperthyroidism)
   (+ post-cardiac surgery)

Question 9

What are the main treatment goals in atrial flutter?

Answer 9

Control heart rate, restore sinus rhythm, and prevent stroke.

Question 10

Which medications are used to control ventricular rate in atrial flutter?

Answer 10

• Calcium channel blockers (e.g. diltiazem)
• Beta blockers (e.g. propranolol)
• Digoxin (less effective during exercise)

Question 11

Which antiarrhythmic drug may be used to restore rhythm?

Answer 11

Amiodarone.

Question 12

Why is anticoagulation important in atrial flutter?

Answer 12

To prevent thrombus formation and stroke, similar to AF.

Question 13

What is the emergency treatment if atrial flutter causes haemodynamic instability?

Answer 13

Synchronized cardioversion (shock delivered in sync with the R wave).

Question 14

What does catheter ablation aim to achieve in atrial flutter?

Answer 14

Destroys the abnormal tissue in the atria responsible for the re-entry circuit, preventing recurrence.

Question 15

How can atrial flutter reduce cardiac output?

Answer 15

Very fast atrial rate + poor ventricular filling → reduced stroke volume → low cardiac output.