Patients can develop atypical atrial flutter after AFib ablation due to circuits created by scarring.Can occur after starting an antiarrhythmic drug for AFib.Similar risk factors for AFib: pulmonary disease, diabetes, HTN, older age, obesity, and thyrotoxicosis 5.Uncommon to occur in a structurally normal heart or without a predisposing event or preexisting comorbidity.Incidence in the US is 200,000 new cases per year 5.80% of patients with atrial flutter are male 6.ECG will be different than typical/reverse flutter.Typically associated with structural heart disease, cardiac surgery, or ablation 5.Atrial tachycardias that are caused by a reentrant circuit that do not involve the cavotricuspid isthmus but any portion of the atria 5.Positive flutter waves in inferior leads and negative atrial deflections in V1.If re-entry is clockwise, this is “reverse” typical flutter.Negative flutter waves in inferior leads II, III, aVF and positive atrial deflections in V1 4.Circuit typically rotates in a counterclockwise direction → “sawtooth” EKG pattern.The slow area of conduction that sustains the circuit is the cavotricuspid isthmus (tissue located between the IVC and tricuspid annulus) 3.Reentrant arrhythmia due to an impulse that rotates around the right atrium.Ratio of 2:1 is most common and produces a ventricular rate of 150 beats/min.Ventricular rate determined by AV conduction ratio.Atrial rate commonly 300 beats/min but can range between 250-350 bpm 2.Can be irregular if there is an AV block. ![]() Narrow, regular-complex tachydysrhythmia due to a single reentrant circuit within the atria.
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