Overview
Definition
A macro-reentrant atrial tachycardia characterized by rapid, regular atrial depolarizations at a rate of ~300 bpm.
Epidemiology
Often coexists with Atrial Fibrillation. Common in patients with structural heart disease or COPD.
Etiology & Risk Factors
- Macro-reentrant circuit typically located in the right atrium (around the tricuspid annulus)
Clinical Symptoms
- Palpitations
- Lightheadedness
- Dyspnea
- Often asymptomatic
Clinical Approach
Diagnosis
- ECG: 'Sawtooth' flutter waves in inferior leads (II, III, aVF), typically with a 2:1 AV block resulting in a ventricular rate of ~150 bpm
Management
- Rate control (Beta-blockers, Non-DHP CCBs)
- Anticoagulation (same stroke risk criteria as A-Fib, using CHA2DS2-VASc)
- Rhythm control: Synchronized cardioversion (if unstable) or Ibutilide
- Catheter ablation is highly successful (>90%) and often preferred as definitive therapy
Complications
- Thromboembolism (Stroke)
- Tachycardia-induced cardiomyopathy