atrial flutter

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Atrial flutter (AF) is fast regular atrial electrical activity with a frequency of 200-400 (traditionally 250-350) per minute. ECG shows typical sawtooth flutter waves FF

    • Regular form of AF – rhythmic excitation and contraction of the ventricles with a frequency lower and a multiple of the frequency of AF waves – 2:1, 3:1, 4:1 due to the presence of AV blockade
    • Irregular form of atrial fibrillation – inconsistent conduction of excitation to the ventricles: the rhythm is irregular, unequal RR intervals. Etiology
    • Rheumatic heart disease (64-69% AF)
    • Atherosclerotic cardiosclerosis (24%)
    • Thyrotoxic myocardial dystrophy (3%)
    • Alcohol intoxication and alcoholic cardiopathy (up to 20% of all cases of paroxysmal AFL)
    • Hypertrophic and dilated cardiomyopathy. Special Studies
    • Transesophageal echocardiography reveals a thrombus in the left ear
    • X-ray examination of the chest organs.

Treatment:

Tactics of conducting

    • Shown hospitalization
    • With stable hemodynamics – control of the frequency of ventricular contractions, treatment of the underlying disease
    • For emergency therapy with the appearance of signs of hemodynamic instability – electrical cardioversion. Drug therapy
    • To eliminate the paroxysm of TP
    • Cardiac glycosides – rapid digitalization (see Atrial fibrillation). In 80% of cases, atrial fibrillation is replaced by flicker (an indication for the immediate abolition of cardiac glycosides) with subsequent restoration of sinus rhythm.
    • Novocaine mid nbsp; 0.5-1 g (5-10 ml of 10% solution) in/in jet drip in 5% glucose solution or in 0.9% NaCl solution at a rate of not more than 100 mg / min for 5-10 minutes under the control of ECG and blood pressure, intramuscularly and orally (see Extrasystole)
    • With the introduction, sharp arterial hypotension is possible (especially when combined with antihypertensive drugs, including B-blockers), atrioventricular conduction disturbances, ventricular tachycardia. With a sharp decrease in blood pressure, mezaton should be administered intravenously
    • Procainamide should be used with caution in severe digitalis intoxication, heart failure, impaired kidney and liver function, severe myasthenia gravis, bronchial asthma
    • Diuretics that cause hypokalemia weaken the effect of novocainamide and increase the likelihood of its proarrhythmic action.
    • Quinidine – see Atrial fibrillation.
    • To maintain a normal ventricular rate with stable hemodynamics
    • (3-blockers (propranolol [anaprilin], metoprolol, atenolol, nadolol)
    • Calcium channel blockers (diltiazem, verapamil) – except in cases of Wolff-Parkinson-White syndrome
    • Cardiac glycosides, such as digoxin (traditionally less effective than B-blockers and calcium channel blockers).

Observation

    • Holter monitoring to assess sinus rhythm maintenance
    • Frequent determination of PV
    • ECG to determine the length of the QT interval in patients receiving antiarrhythmic therapy.

See also Wolff-Parkinson-White Syndrome, Atrial FibrillationContraction. TP – atrial flutter ICD 148 Atrial fibrillation and flutter