Atrial Flutter (Flutter, Atrial)

Rapid, irregular atrial contractions caused by a block of electrical impulse conduction in the right atrium and a reentrant wave front traveling up the inter-atrial septum and down the right atrial free wall or vice versa. Unlike ATRIAL FIBRILLATION which is caused by abnormal impulse generation, typical atrial flutter is caused by abnormal impulse conduction. As in atrial fibrillation, patients with atrial flutter cannot effectively pump blood into the lower chambers of the heart (HEART VENTRICLES).

Also Known As:

Networked: 1417 relevant articles (149 outcomes, 194 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Atrial Fibrillation
2.	Tachycardia (Tachyarrhythmias)
3.	Supraventricular Tachycardia
4.	Ventricular Tachycardia
5.	Cardiac Arrhythmias (Arrythmia)

Experts

1.	Waldo, Albert L: 10 articles (06/2015 - 05/2004)
2.	Hohnloser, Stefan H: 9 articles (12/2014 - 07/2004)
3.	Crijns, Harry J G M: 9 articles (12/2014 - 11/2002)
4.	Torp-Pedersen, Christian: 9 articles (06/2012 - 09/2003)
5.	Friedman, Paul A: 9 articles (09/2009 - 03/2002)
6.	Ammash, Naser M: 8 articles (10/2013 - 05/2003)
7.	Page, Richard L: 8 articles (11/2012 - 04/2002)
8.	Connolly, Stuart J: 8 articles (05/2012 - 04/2002)
9.	Willems, Stephan: 8 articles (01/2011 - 04/2003)
10.	Feld, Gregory K: 7 articles (06/2015 - 10/2004)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Atrial Flutter:

1.	ibutilide (Corvert)FDA LinkGeneric 01/01/2005 - "Ibutilide is highly effective for rapidly terminating atrial flutter. " 02/01/2004 - "Ibutilide is particularly effective in rapid termination of atrial flutter (AFL) with few adverse effects. " 01/01/2002 - "Ibutilide appears to be an effective and well tolerated drug for rapid conversion of recent-onset atrial flutter in octogenarian patients, and may represent a valid approach in the acute management of atrial flutter in this particular set of patients." 05/01/1998 - "Ibutilide fumarate is an intravenous (IV) class III antiarrhythmic agent that has been shown to be significantly more effective than placebo in the pharmacologic conversion of atrial flutter and fibrillation to sinus rhythm. " 07/01/1993 - "The results demonstrate oral efficacy of ibutilide with rapid onset of action (in 30-60 min), resulting in increased AERP and prevention of induced atrial flutter in this model."
2.	dronedaroneFDA Link 06/01/2010 - "Clinical studies have shown that dronedarone effectively reduces ventricular rate, may prevent or delay the recurrence of AF, and may reduce cardiovascular morbidity and mortality in patients with AF or atrial flutter. " 09/01/2009 - "Phase III clinical trials have shown dronedarone to be effective at reducing ventricular rate, reducing recurrence of AF, and reducing cardiovascular morbidity and mortality in patients with AF or atrial flutter (AFL). " 08/20/2009 - "Oral dronedarone was generally well tolerated in the treatment of adult patients with AF and/or atrial flutter in clinical studies. " 08/20/2009 - "Dronedarone exhibited rate- and rhythm-controlling properties in patients with atrial fibrilation (AF) or atrial flutter, significantly reducing the risk of a first recurrence of AF versus placebo following 12 months' therapy in the ADONIS and EURIDIS studies. " 05/01/2013 - "In conclusion, dronedarone is associated with frequent adverse events and moderate antiarrhythmic efficacy requiring discontinuation in most patients within the first 9 months of use, and there is a prevalent reversal from persistent to paroxysmal but also from paroxysmal to persistent atrial arrhythmias and from AF to non-isthmus-dependent atrial flutter."
3.	Propafenone (Rythmol)FDA LinkGeneric 09/15/1991 - "Propafenone was effective in 33 of 37 patients (89%); atrial flutter was controlled in 2 patients, ventricular ectopy was suppressed in 1 of 2 patients. " 08/01/1991 - "Propafenone is effective in greater than 50% of patients with paroxysmal atrial flutter or fibrillation, resistant to other antiarrhythmic agents. " 02/01/1996 - "We can conclude that propafenone is effective and safe when used with transesophageal pacing in the termination of atrial flutter. " 12/15/1995 - "We conclude that propafenone is effective and safe when used with transesophageal pacing in the termination of atrial flutter. " 02/15/1997 - "Efficacy of intravenous propafenone in termination of atrial flutter by overdrive transesophageal pacing previously ineffective."
4.	Verapamil (Calan)FDA LinkGeneric 10/01/2012 - "(3) One of them suffered from atrial flutter on 38 + 3 weeks of gestation which was restored to sinus rhythm after being treated with verapamil and remained stable afterward. " 01/24/2008 - "After an electrocardiography (ECG) revealed atrial flutter (AFL) during palpitation, which was resistant to administered verapamil, the patient was admitted to our hospital for curative treatment. " 09/01/1994 - "The atrial flutter responded to an injection of verapamil and changed to a 2:1 conduction. " 03/01/1992 - "Verapamil significantly shortened flutter-cycle length but suppressed atrial-flutter induction in only one of seven patients. " 08/20/1989 - "Acute drug treatment of recent onset atrial flutter may reduce the ventricular rate by increasing block in the A-V node (digitalis/verapamil) or act by directly affecting the atria by reducing the atrial rate or converting flutter to sinus rhythm (1a and 1c antiarrthythmic drugs). "
5.	Flecainide (Tambocor)FDA LinkGeneric 12/01/1993 - "Flecainide is effective in terminating stable atrial flutter in the conscious dog with a Y-shaped right atrial lesion. " 03/01/2004 - "Although the efficacy of flecainide for atrial flutter during the infantile or childhood period is low, intravenous flecainide is worth consideration as a treatment for atrial flutter, even in intractable cases as described here, during the neonatal period." 01/01/2015 - "Our case demonstrates two arrhythmias caused by flecainide: atrial flutter with 1:1 atrioventricular conduction and TDP. " 01/01/2015 - "Pacemaker interrogation revealed evidence of an undiagnosed atrial flutter, at presentation this was likely slowed by flecainide toxicity to a rate below the pacemaker mode switch, such that it was tracked in the ventricle at the upper tracking rate (120 bpm). " 09/01/2011 - "A diagnosis of class IC atrial flutter with aberrant ventricular conduction caused by flecainide therapy was formulated. "
6.	Procainamide (Procan)FDA LinkGeneric 02/01/1988 - "It is concluded that intravenous procainamide effectively augments the efficacy of rapid atrial pacing to convert atrial flutter to sinus rhythm." 02/01/1988 - "Twelve patients with spontaneous atrial flutter that had been present for greater than 24 h were studied to assess the efficacy of atrial pacing, alone and in combination with procainamide, to convert atrial flutter to normal sinus rhythm. " 05/01/1997 - "In conclusion, intravenous procainamide augments the efficacy of atrial pacing to convert atrial flutter to sinus rhythm." 05/01/1997 - "In a prospective, double-blind, randomized, placebocontrolled study we investigated the facilitating influence of intravenous procainamide on conversion of atrial flutter by rapid atrial pacing. " 03/01/2002 - "Pronounced effect of procainamide on clockwise right atrial isthmus conduction compared with counterclockwise conduction: possible mechanism of the greater incidence of common atrial flutter during antiarrhythmic therapy."
7.	Sotalol (Sotalol Hydrochloride)FDA LinkGeneric 02/01/1996 - "Sotalol significantly increased AFL CL 23 +/- 3 msec and terminated atrial flutter in 8 of 12 trials following a mean dose of 1.5 +/- 0.4 mg/kg. AERP and VERP were significantly increased 20 +/- 6 and 12 +/- 2 msec, respectively. " 03/01/2006 - "Sotalol may be considered the drug of choice for fetal atrial flutter. " 03/01/2006 - "Fetal atrial flutter: a case report and experience of sotalol treatment." 09/01/1997 - "The postnatal course was complicated by the development of atrial flutter successfully treated with sotalol. " 08/01/1992 - "Activation maps were recorded during sinus rhythm before and after crush injury, during rapid pacing above and below the crush injury, and during sustained atrial flutter, entrainment of atrial flutter, and termination of atrial flutter induced with D-sotalol (2 mg/kg). "
8.	Amiodarone (Amiodarona)FDA LinkGeneric 10/17/2006 - "There is no published randomized study comparing amiodarone therapy and radiofrequency catheter ablation (RFA) after only 1 episode of symptomatic atrial flutter (AFL). " 10/17/2006 - "Results from the Loire-Ardèche-Drôme-Isère-Puy-de-Dôme (LADIP) trial on atrial flutter, a multicentric prospective randomized study comparing amiodarone and radiofrequency ablation after the first episode of symptomatic atrial flutter." 12/01/2004 - "The study consisted of 83 patients with isthmus-dependent atrial flutter: 52 were taking amiodarone at the time of RFA (group 1) and 31 were in a drug-free state (group 2). " 12/01/2004 - "The aim of our study was to assess the value of entrainment mapping in the presence of amiodarone in patients undergoing radiofrequency ablation (RFA) of isthmus-dependent atrial flutter. " 01/01/2013 - "She was recently diagnosed with refractory atrial flutter and was prescribed amiodarone. "
9.	Digoxin (Digitek)FDA LinkGeneric 10/01/1996 - "The results presented stress the efficacy of digoxin for fetal atrial flutter as well as the usefulness of prenatal echocardiography in the assessment of anatomical, functional, and rhythmic conditions of the fetal heart." 02/01/1998 - "Although the suppression rate of incessant atrial flutter with digoxin is only 50%, this therapy may be useful for its positive inotropic and negative chronotropic properties. " 05/01/1994 - "Successful conversion of fetal atrial flutter with digoxin: report of one case." 01/01/1992 - "One quarter of the patients had atrial flutter in addition to fibrillation, and this alternation with flutter was significantly associated with the use of a type 1A antiarrhythmic drug (p = 0.007), but not with the use of digoxin or beta blockers (p = NS for both). " 08/01/2012 - "Transplacental digoxin therapy for fetal atrial flutter with hydrops fetalis."
10.	Anti-Arrhythmia AgentsIBA 01/01/1996 - "Atrial flutter shows different behaviour regarding the very limited efficacy of antiarrhythmic drugs for reversion to and maintenance in sinus rhythm." 01/01/2009 - "60 patients who underwent ablation for electrophysiologically proven isthmus dependent right atrial flutter, who were not on Class I or Class III antiarrhythmic drugs and had recent 2-dimensional echocardiographic data comprised the study group. " 08/01/2007 - "After excluding patients with atrial flutter and those receiving antiarrhythmic drugs, 454 patients qualified for the study. " 10/01/2004 - "The objective of this study was to evaluate whether the recurrence rate of isthmus-dependent atrial flutter was greater in patients previously medicated with antiarrhythmic drugs and whether there were differences in recurrence rate with different types of antiarrhythmic drugs. " 01/01/2015 - "After the procedure, 9 patients still presented paroxymal rapid firing within the SVC in the setting of SR restoration, 2 patients developed paroxysmal atrial flutter within 1 month after completion of ablation and were controlled by antiarrhythmic drugs. "

Therapies and Procedures

1.	Electric Countershock (Cardioversion) 01/01/1997 - "Electrical cardioversion was an effective and safe method of converting chronic atrial flutter to sinus rhythm. " 02/01/2013 - "Elective direct current cardioversion is considered first-line treatment in many cases of atrial flutter and fibrillation. " 11/19/2010 - "A pilot study was performed to determine the efficacy of low energy biphasic external cardioversion in common type atrial flutter. " 03/01/2006 - "The efficacy of biphasic waveform cardioversion of atrial flutter in pediatric patients has not previously been demonstrated. " 03/01/2006 - "Efficacy of biphasic waveform compared to monophasic waveform for cardioversion of atrial flutter in pediatric patients."
2.	Catheters 07/01/2001 - "In conclusion, radiofrequency catheter modification or ablation of the AVN for rapid AF and ablation for atrial flutter type I are demonstrated to be highly effective in the majority of ICD patients with drug refractory multiple inappropriate ICD therapies." 10/01/2002 - "Use of the closed cooled-tip ablation catheter and the 8-mm-tip catheter have equal and high efficacy for RF ablation of common atrial flutter." 06/01/2014 - "Both ablation catheters with irrigated system and 8mm tip-catheters have shown to be more effective for typical atrial flutter radiofrequency (RF) ablation when compared to conventional 4 mm tip catheter. " 03/01/2007 - "Both ablation catheters with closed irrigated system and 8mm tip-catheters have been shown to be more effective for typical atrial flutter radiofrequency (RF) ablation when compared to conventional 4 mm tip catheter. " 02/01/2006 - "Irrigated tip catheters are effective and safe in ablation of common atrial flutter. "
3.	Electrodes (Electrode) 07/01/1987 - "To determine the efficacy of transesophageal rapid atrial pacing with a "pill-electrode" for the termination of atrial flutter, we studied 14 consecutive unselected patients presenting with atrial flutter of various etiologies. " 04/01/2007 - "The purpose of this study was to evaluate termination of atrial flutter (AFL) by directed rapid transesophageal atrial pacing (TAP) with and without simultaneous transesophageal echocardiography (TEE) performed using a novel TEE tube electrode. " 08/17/1999 - "The prospective, randomized study comparing 4- with 8-mm tip electrodes for radiofrequency linear ablation of typical atrial flutter is not available. " 09/01/1996 - "We utilized these electrodes to study the spontaneous onset of type 1 atrial flutter in 16 patients in the postoperative period after open heart surgery. " 04/01/1991 - "Then, in 11 open chest studies, atrial electrograms were recorded simultaneously from 95 pairs of right atrial electrodes during the onset of 18 episodes of induced atrial flutter (mean cycle length 136 +/- 16 ms). "
4.	Drug Therapy (Chemotherapy) 06/01/1989 - "The present study suggests that transesophageal pacing is highly effective for interrupting spontaneous atrial flutter that does not terminate with standard antiarrhythmic drug therapy." 03/01/2006 - "The efficacy of antiarrhythmic drug therapy for fetal atrial flutter has not been well established. " 01/01/2009 - "Right atrial flutter cycle length can prolong in the presence of antiarrhythmic drug therapy. " 08/01/2008 - "The transient atrial rhythm intervened between atrial flutter (AFL) and its termination during class III antiarrhythmic drug therapy for AFL has not been characterized well. " 04/18/2006 - "During a mean follow-up of 11+/-4 months, 77% of patients were free from AF and/or atrial flutter without antiarrhythmic drug therapy. "
5.	Ablation Techniques 06/01/2010 - "Efficacy of bundle ablation for cavotricuspid isthmus-dependent atrial flutter: combination of the maximum voltage-guided ablation technique and high-density electro-anatomical mapping." 03/15/1996 - "However, in Group II, the procedure time (104 +/- 17 vs. 181 +/- 29 min, p<0.01) were significantly shorter than those in Group I. Radiofrequency ablation of the common atrial flutter circuit was safe and effective with either the electrophysiologically guided focal ablation or linear ablation technique. " 03/15/1996 - "The purpose of this study was to study electrophysiologic characteristics and compare the electrophysiologically guided focal ablation technique and linear ablation technique in patients with common atrial flutter in a prospective randomized fashion. " 06/01/2012 - "Voltage-guided ablation technique for cavotricuspid isthmus-dependent atrial flutter: refining the continuous line." 12/01/2007 - "Achievement of complete conduction block in the cavotricuspid isthmus (CTI) is a curative ablation technique in patients with common atrial flutter (AFL). "