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We provide our users the most up-to-date and accurate information on the treatment and prevention of cardio pathologies in accordance with current American and European clinical guidelines.
The information provided on this website is for educational purposes only and should not be considered medical advice. Always consult a licensed physician for diagnosis and treatment.
Atrial Flutter with Rapid Ventricular Response (AFL with RVR)
Introduction
Atrial flutter (AFL) is a type of supraventricular tachycardia (SVT) characterized by rapid, regular atrial contractions, typically around 250-350 beats per minute. When atrial flutter is associated with a rapid ventricular response (RVR), it can lead to significant hemodynamic instability.
Pathophysiology
- Atrial Flutter: A re-entrant rhythm within the atria leads to rapid, organized electrical activity.
- Rapid Ventricular Response (RVR): The atrioventricular (AV) node conducts many of these rapid atrial signals to the ventricles, resulting in a rapid heart rate (>100 bpm), potentially leading to symptoms such as palpitations, dizziness, and even heart failure.
Symptoms
- Palpitations
- Shortness of breath
- Dizziness or presyncope
- Fatigue
- Chest discomfort
Diagnosis
- Electrocardiogram (ECG): Classic “sawtooth” flutter waves, best seen in leads II, III, and aVF.
- Echocardiography: Evaluates structural heart disease and atrial function.
- Blood Tests: Check electrolyte levels, thyroid function, and markers of cardiac stress.
Treatment
1. Acute Management
- Rate Control: Beta-blockers (e.g., metoprolol) or calcium channel blockers (e.g., diltiazem) to slow ventricular rate.
- Rhythm Control: Electrical cardioversion if hemodynamically unstable.
- Anticoagulation: Prevent thromboembolism, especially if lasting >48 hours.
2. Long-Term Management
- Catheter Ablation: A curative option for recurrent atrial flutter.
- Antiarrhythmic Drugs: Class IC (flecainide, propafenone) or Class III (amiodarone, sotalol).
- Anticoagulation Therapy: Based on CHA₂DS₂-VASc score.
Conclusion
Atrial flutter with RVR is a serious cardiac arrhythmia that requires prompt recognition and management to prevent complications like stroke and heart failure. Patients should be closely monitored and treated based on their individual risk profile.
Source recommendations
1. 2023 European Society of Cardiology Guidelines on Atrial Fibrillation
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Atrial-Fibrillation
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193
- https://www.jacc.org/doi/10.1016/j.jacc.2023.10.021
- https://pubmed.ncbi.nlm.nih.gov/32860505/
- https://www.jscai.org/article/S2772-9303(22)00617-2/fulltext
2. American Heart Association Guidelines for the Management of Atrial Arrhythmias
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193
- https://professional.heart.org/en/science-news/2023-acc-aha-accp-hrs-guideline-for-the-diagnosis-and-management-of-atrial-fibrillation
- https://www.heart.org/en/health-topics/atrial-fibrillation
- https://pubmed.ncbi.nlm.nih.gov/38033089/
- https://www.heart.org/en/health-topics/arrhythmia
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If you or your loved ones experience any of these symptoms, you should consult a doctor in time. Remember that self-medication can be dangerous, and timely diagnosis will preserve the quality and life expectancy.
The heart is an organ that does not know how to "keep silent" if something goes wrong. Chest pain, shortness of breath, swelling, dizziness, and rhythm disturbances are the symptoms that require our attention. The best prevention of heart disease is careful attention to your health, regular checkups with a doctor, and a healthy lifestyle. Take care of your heart, and it will serve you for many years!
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