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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 2:1 Conduction
Introduction
Atrial flutter is a type of supraventricular tachycardia characterized by an organized, rapid electrical circuit in the atria, typically around 250–350 beats per minute. When the AV node conducts every second impulse, it results in a ventricular rate of approximately 150 beats per minute, known as 2:1 conduction.
Causes and Risk Factors
Common causes include: - Structural Heart Disease (e.g., mitral valve disease, cardiomyopathy) - Hypertension - Coronary Artery Disease - Hyperthyroidism - Electrolyte Imbalances - Pulmonary Disease (e.g., COPD, pulmonary embolism) - Post-Cardiac Surgery
Symptoms
- Palpitations (fast, regular heartbeats)
- Shortness of breath
- Dizziness or syncope (fainting)
- Chest discomfort or pain
- Fatigue
Diagnosis
A 12-lead ECG typically shows: - Regular atrial flutter waves (sawtooth pattern, best seen in leads II, III, and aVF) - Ventricular rate around 150 bpm ( - Absence of isoelectric baseline between P waves - Narrow QRS complexes unless pre-existing bundle branch block
Treatment Approaches
1. Acute Management
- Hemodynamically Unstable: Immediate electrical cardioversion (synchronized)
- Stable but Symptomatic:
- Rate control (Beta-blockers, Non-dihydropyridine Calcium Channel Blockers)
- Consider anticoagulation (CHA₂DS₂-VASc score assessment)
- Possible cardioversion (electrical or pharmacological)
2. Long-Term Management
- Rate Control: Beta-blockers (e.g., metoprolol) or calcium channel blockers (e.g., diltiazem)
- Rhythm Control: Antiarrhythmic drugs (e.g., amiodarone, sotalol, flecainide)
- Catheter Ablation: Highly effective in eliminating atrial flutter
- Stroke Prevention: Anticoagulation if CHA₂DS₂-VASc score indicates risk
Summary
Atrial flutter with 2:1 conduction presents as a fast, organized rhythm with a ventricular rate of about 150 bpm. Management depends on stability, with cardioversion for unstable patients, rate control for symptomatic relief, and catheter ablation as a definitive solution.
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. 2023 American Heart Association/American College of Cardiology/Heart Rhythm Society Guidelines for the Management of Patients with Atrial Fibrillation
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193
- https://pubmed.ncbi.nlm.nih.gov/38033089/
- https://www.hrsonline.org/guidance/clinical-resources/2023-accahaaccphrs-guideline-diagnosis-and-management-patients-atrial-fibrillation
- https://www.jacc.org/doi/10.1016/j.jacc.2023.10.021
- https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2023/11/27/19/46/2023-acc-guideline-for-af-gl-af
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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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