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Atrial Flutter and Macroreentrant Atrial Tachycardias

Atrial Flutter and Macroreentrant Atrial Tachycardias. Macroreentrant arrhythmias involving the atrial myocardium are referred to collectively as AFL. N onfocal source . Typical / atypical. Right AFL / left AFL. Clockwise / counterclockwise. Atrial rate of 260–300 .

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Atrial Flutter and Macroreentrant Atrial Tachycardias

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  1. Atrial Flutter and MacroreentrantAtrialTachycardias • Macroreentrant arrhythmias involving the atrial myocardium are referred to collectively as AFL. • Nonfocal source. • Typical / atypical. • Right AFL / left AFL. • Clockwise / counterclockwise.

  2. Atrial rate of 260–300. • Ventricular response that tends to be 2:1, so ventricular rate of 130-150.

  3. Treatment: Atrial Flutter • Cardioversion of 50–100 J. • Anticoagulation. • Tachycardia-induced severe LV dysfunction. • Pharmacologic cardioversion with procainamide, amiodarone, or ibutilide. • Ablative therapy.

  4. Multifocal Atrial Tachycardia • Pulmonary diseases. • At least three distinct P-wave morphologies and often at least three different PR intervals. • Atrial and ventricular rates are typically between 100 and 150.

  5. Treatment: Multifocal Atrial Tachycardia • Underlying lung disease. • Verapamil. • Flecainide or propafenone. • Low-dose amiodarone.

  6. PSVT • Reentry. • SA nodal reentry. • Atrial reentry. • AV nodal reentry. • Macroreentrant circuit reentry.

  7. AV Nodal Reentrant Tachycardia • The most common type of PSVT. • Moslty in the absence of structural heart disease. • Usually well tolerated. • Syncope or dizziness if SHD is present.

  8. ECG Findings in AVNRT: • The APC. • Heart rate of 120 to 250 beats/min. • Simultaneous activation of ventricles and atriums.

  9. Acute Treatment of AVNRT: • Valsalva maneuver or carotid sinus massage. • Adenosine. • Beta blockers or calcium channel blockers. • If hemodynamic compromise, DC cardioversion of 100 – 200 J.

  10. Prevention: • Slow conduction in the slow pathway. • If persists, slow conduction in the fast pathway. • Ablation in selected patients.

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