In this episode, we review atrial flutter, a supraventricular tachyarrhythmia caused by a reentrant electrical circuit within the atria that produces the classic "sawtooth" flutter waves on EKG. We discuss the underlying pathophysiology, major risk factors including heart failure, COPD, coronary artery disease, hypertension, hyperthyroidism, and obstructive sleep apnea, and the typical presentation of palpitations, dyspnea, fatigue, and chest pain. Diagnostic evaluation focuses on recognizing the characteristic 2:1 AV conduction pattern with atrial rates near 300 bpm and ventricular rates around 150 bpm. We also cover acute management with rate control, rhythm control, and cardioversion, as well as long-term treatment strategies including catheter ablation and anticoagulation guided by the CHA₂DS₂-VASc score.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Writing Committee Members, Joglar JA, Chung MK, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2024;83(1):109-279. doi:10.1016/j.jacc.2023.08.017
3. Wolfes, J, Ellermann, C, Frommeyer, G. et al. Comparison of the Latest ESC, ACC/AHA/ACCP/HRS, and CCS Guidelines on the Management of Atrial Fibrillation. J Am Coll Cardiol EP. 2025 Apr, 11 (4) 836–849.
4. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):e199-e267. doi:10.1161/CIR.0000000000000041