ABSTRACT
The incidence of atrial flutter (AFL) rises exponentially in relationship to advancing age but as it is for AF, is greatest with structural heart disease such as left atrial enlargement or ventricular dysfunction. This chapter discusses epidemiology and risk factors, clinical presentation, and diagnosis of AFL. Acutely, patients often complain of shortness of breath, palpitations, diaphoresis, chest discomfort, dizziness, and weakness. Patients may also complain of polyuria, which occurs as a result of increased atrial pressure from rapidly contracting atria against a closed AV valve, and the subsequent release of atrial natriuretic factor. The diagnosis of AFL is generally made on a 12-lead surface ECG by identifying flutter waves in leads II, III, aVF, and V1. When it is difficult to distinguish the flutter waves, slowing the ventricular rate, by using AV nodal blockers (e.g., adenosine or diltiazem) or vagal maneuvers (Valsalva or gentle carotid sinus message), may allow visualization of the flutter waves.
