Atrial flutter is an incorrect form of cauterization treatment. Instrumental treatment - cardioversion-defibrillation

Description:

Atrial flutter is a significant increase in atrial contractions (up to 200-400 per minute) while maintaining the correct regular atrial rhythm.

Due to the high frequency of atrial impulses, it is usually accompanied by an incomplete atrioventricular block, which provides a rarer ventricular rhythm.

Treatment for atrial flutter:

Treatment and secondary prevention of atrial flutter is generally carried out in the same way as with their flicker. At the same time, it should be noted that atrial flutter is significantly more resistant to drug therapy, both in stopping paroxysms and in preventing them, which sometimes creates big problems. Significant difficulties can also arise in the pharmacological control of the ventricular rate. At the same time, due to the instability of atrioventricular conduction during atrial flutter, it is somewhat long-term preservation is undesirable, and maximum efforts should be made to restore sinus rhythm as soon as possible or to convert flutter to flicker.

For the relief of paroxysms of atrial flutter, drug therapy, electrical cardioversion and frequent atrial pacing are used.

As with atrial fibrillation, class IA, 1C, and III antiarrhythmic drugs are used to restore sinus rhythm, which are administered intravenously or orally. The last two groups of drugs are more effective and less toxic than the first. It should be noted in particular that with regard to new drug ibutilide at intravenous administration allows you to restore sinus rhythm in about 70% of patients.

It should be emphasized that in order to avoid a sharp increase in heart rate as a result of an improvement in atrioventricular conduction, up to 1:1, an attempt at medical cardioversion with drugs of classes IA and 1C can be carried out only after blocking the atrioventricular node with digoxin, verapamil, diltiazem or ß- blockers.

Verapamil is the drug of choice for drug control of ventricular rate in atrial flutter. A less permanent effect is provided by ß-blockers and digoxin. Due to the resistance of flutter to digoxin, comparatively large doses drug. In general, heart rate control with drugs that slow atrioventricular conduction is much less reliable in this rhythm disorder than in atrial fibrillation. With its ineffectiveness, non-drug methods are successfully used - catheter ablation and modification of the atrioventricular node.

Atrial flutter (AF)- this is one of the most common cardiac arrhythmias, it accounts for about 10% of all paroxysmal supraventricular tachyarrhythmias. It is a common complication of acute myocardial infarction and open heart surgery. Other causes of atrial flutter include chronic lung disease, pericarditis, thyrotoxicosis, rheumatism (especially in people with mitral stenosis), dysfunction of the sinus node (tachy-brady syndrome), as well as other diseases that contribute to atrial dilatation. Atrial flutter can occur in patients of almost any age. However, in those who have heart disease, it is much more common.

Atrial fibrillation (AF)- this is a supraventricular tachyarrhythmia, characterized by uncoordinated electrical activation of the atria at a frequency of 350-700 per minute, which causes a deterioration in atrial contractility and the actual loss of the atrial filling phase of the ventricles.

Atrial fibrillation is one of the most common and frequently encountered arrhythmias in clinical practice.

Clinical manifestations

Typically, patients with atrial flutter complain of sudden palpitations, shortness of breath, general weakness, intolerance physical activity or pain in chest. However, more severe clinical manifestations are possible - syncope, dizziness due to hypotension, and even cardiac arrest, due to a higher rate of ventricular contraction. The pathophysiological basis of this symptomatology is a decrease in systemic output, systemic blood pressure and decrease coronary blood flow. According to some reports, a decrease in coronary blood flow can reach 60% with an increasing myocardial oxygen demand. Due to serious hemodynamic disorders, systolic dysfunction of the heart develops, followed by dilatation of its cavities, ultimately leading to heart failure.

Classification of atrial flutter

atrial flutter- this is a fast, regular atrial tachyarrhythmia with a frequency of excitation and atrial contraction of more than 200 per minute. It is now generally accepted that this arrhythmia is based on the mechanism of re-entry of excitation.

Typical AF is due to the right atrial circle of macroreentry, limited in front by the annulus of the tricuspid valve, and behind by anatomical obstacles (openings of the superior and inferior vena cava, Eustachian crest) and a functional barrier in the form of a terminal crista. In this case, the excitation wave passes through the lower isthmus (delayed conduction zone), located between the inferior vena cava and the perimeter of the tricuspid valve. This is the so-called isthmus-dependent TP: it can be supervised by RF exposure in this area.

Depending on the direction of the depolarization wave in the atria, two types of typical AF are distinguished:

— TP with activation interatrial septum(MPP) in the caudocranial direction, and the lateral parts of the right atrium (RP) - in the craniocaudal direction, i.e. with the circulation of the excitation wave around the tricuspid valve counterclockwise (CCW) when viewed from the apex of the heart. On the ECG, it is characterized by negative F waves in leads II, III, aVF, reflecting synchronous MPP activation from the bottom up, and positive flutter waves in lead V1. The descending knee of the F-waves in the inferior standard and augmented leads is longer (flatter) than the ascending (steeper) one. An important point is the markedly lower amplitude of atrial electrical activity complexes in lead V1, which are projected onto the ascending phase of TP waves in lead aVF;

— AF with opposite activation of the structures of the right atrium, i.e. with the circulation of the excitation wave clockwise (CW), electrocardiographically characterized by a positive direction of the flutter waves in the lower standard and enhanced leads and comparable in amplitude to the F-waves in lead V1 .

However, characteristic ECG signs in patients may not always be, therefore, only during endoEPS, it is possible to prove the interest of the cavatricuspid isthmus.

Isthmus-dependent tachycardias, in addition to typical AF, are two-wave and lower loop atrial flutter. Two-wave TP is characterized by the formation of two waves of depolarization in the AP, circulating one after another around the annulus of the tricuspid valve in the same direction, resulting in an acceleration of TP. At the same time, the geometry of atrial activation on the surface ECG does not undergo significant changes. This type of arrhythmia probably has little clinical significance, since it persists for a short period of time (up to 11 complexes), subsequently turning into typical AF, less often into atrial fibrillation.

Inferior-loop AT is characterized by a breakthrough of the excitation wave through the terminal cristae (TC) in its different parts with the formation of a re-entry circle around the orifice of the inferior vena cava with counterclockwise impulse circulation (CWW). In this case, the electrocardiographic characteristic of TP will depend on the level of conduction through the borderline sulcus. It will vary from an ECG pattern identical to typical AFL/CWW, with a slight decrease in the amplitude of the positive phase of the flutter wave in the inferior leads and the P wave in lead V1, reflecting the collision of oncoming depolarization fronts in the region of the fornix of the right ventricle (with a breakthrough of the AFL wave in the region of the caudal part TC) to an ECG pattern characteristic of a typical TP/CW, which will be a reflection of MPP activation in the craniocaudal direction (with a breakthrough in the region of the cranial TC). These types of AFL, as well as typical forms of AFL, are amenable to radiofrequency ablation in the region of the lower isthmus.

The isthmus-independent atrial flutter includes upper loop, multiple cycle, and left atrial flutter. In case of upper loop TP, the depolarization wave, breaking through the TC, forms a re-entry circle in the region of the roof of the right ventricle along the perimeter of the superior vena cava with the pulse circulating clockwise, while lower divisions PPs are not involved in the TP cycle. The geometry of atrial activation on the surface ECG is similar to typical TP/CW.

Multicycle AF is characterized by the presence of several cycles of atrial activation simultaneously due to the possibility of multiple breakthroughs of excitation waves through the TC.

In more rare cases macroreentry circles can form in the left atrium and occur more frequently in patients who have undergone surgery on the left atrium. The electrocardiographic picture in these variants of LT will be very variable.

Treatment of atrial flutter

emergency therapy

Emergency care for AFL depends on the clinical manifestations. Patients with acute vascular collapse, cerebral ischemia, angina pectoris, or with increasing manifestations of heart failure, emergency synchronized cardioversion is indicated. Successful restoration of sinus rhythm can be achieved with a shock of less than 50 J using single-phase currents, and with biphasic currents even with less energy. The use of class Ia, Ic and III drugs increases the chances of using electrical impulse therapy.

Frequent atrial pacing, either transesophageal or intraatrial, is the method of choice for restoring sinus rhythm. According to the medical literature, its effectiveness averages 82% (from 55 to 100%). Ultra-frequent pacing is especially justified in AFL after cardiac surgery, since epicardial atrial electrodes are often left in these patients in the postoperative period. Atrial pacing (ECS) should be started at a rate that is 10 pulses higher than the spontaneous atrial electrical activity in atrial fibrillation. To verify the effective entry into the tachycardia cycle, it is recommended to increase the frequency of the ECS with an increment of 10 extrastimuli. A sharp change in the morphology of the TP waves on the surface ECG in standard inferior and enhanced leads indicates the switching (resetting) of the TP. The cessation of the pacemaker at this point may be accompanied by the restoration of sinus rhythm. The critical frequency required to terminate the first type of AF is usually 15-25% higher than the flutter frequency. The use of quinidine, disopyramide, novocainamide, propafenone, ibutilide increases the chances of the effectiveness of ultra-frequent stimulation to restore sinus rhythm. Attempts to terminate AFL by overfrequency pacing can often lead to induction of atrial fibrillation, which often precedes spontaneous return to sinus rhythm. The induction of atrial fibrillation is more likely when using a more "high-speed" mode of ultra-frequent stimulation (the length of the cycle during stimulation exceeds the TP cycle by 50% or more).

A number of drugs (ibutilide, flecainide) effectively restore sinus rhythm in AFL, but significantly increase the risk of developing fusiform ventricular tachycardia. Neither AV conduction inhibitors nor cordarone have been shown to be effective in restoring sinus rhythm, although they can effectively control heart rate.

In most cases, with AV conduction 2:1 or higher, patients do not have hemodynamic disturbances. In such a situation, the clinician may opt for drugs that slow AV conduction. The drugs of choice should be considered calcium antagonists (non-dihydroperidine series) and adrenoblockers. Adequate, although difficult to achieve, rate control is especially important if restoration of sinus rhythm is delayed (eg, if anticoagulant therapy is required). Moreover, if medical cardioversion is planned, control of tachysystole is necessary, since antiarrhythmic drugs, such as class Ic drugs, can decrease the atrial rate and cause a paradoxical increase in the ventricular rate due to slowing of latent AV conduction, which will worsen the patient's clinical status.

If AFL lasts more than 48 hours, patients should be treated with anticoagulant therapy before electrical or medical cardioversion.

Permanent drug therapy

Chronic pharmacological prophylactic therapy for AFL is usually imperial, and its effectiveness is determined by trial and error. Traditionally, dual therapy has been recommended, using both a drug that effectively blocks conduction at the atrioventricular junction and a membrane-active agent. The exception is class III drugs (sotalol, cordaron), which combine the features of all classes of antiarrhythmic therapy.

Catheter ablation of the cavotricuspid isthmus in isthmus-dependent atrial flutter

It is now recognized that the creation of a complete bidirectional blockade in the isthmus between the inferior vena cava and the perimeter of the tricuspid valve using radiofrequency catheter ablation (RFA) is a highly effective and safe procedure for the elimination of AFL and is gradually taking a leading position in the structure various ways treatment of these arrhythmias. Radiofrequency ablation can be performed either during LT or during sinus rhythm. Previously, it was believed that the criterion for the effectiveness of the operation is the relief of atrial fibrillation. Subsequently, stringent criteria for achieving bidirectional conduction block in the inferior isthmus region were developed, which significantly increased the long-term effectiveness of RFA.

In the X-ray surgical center GVKG them. acad. N. N. Burdenko in the period from 1999. to 2004 performed more than a hundred interventions for typical atrial flutter. Verification of the conduction block in the region of the lower isthmus was carried out on the basis of local criteria for achieving conduction blockade in the area of ​​interest and on the basis of the traditional technique for verifying the conduction block (indirectly). The effectiveness of the procedure without maintenance AAT according to the results of prospective observation was 88%. Combined management of patients included: implantation of a system for a permanent pacemaker, repeated interventions in the area of ​​the pulmonary veins, the resumption of AAT. Under these conditions, effective control of sinus rhythm during the calendar year was achievable in 96% of all patients. clinical observations. We have proven significant improvement pumping function of the atria, which may ultimately explain the significant positive clinical dynamics. The quality of life was significantly higher in patients after RFA.

Another prospective randomized trial compared the efficacy of permanent oral AAT (61 patients with AFL) and radiofrequency ablation. At dynamic observation, which was 21±11 months, sinus rhythm was maintained only in 36% of patients treated with AAT, while after RFA - in 80% of patients. In addition, 63% of patients receiving permanent drug therapy, required one or more hospitalizations, compared with 22% of RFA patients.

An absolute indication for AF RFA is when resistance to or intolerance to multiple AAT develops, or when the patient does not wish to receive long-term AAT. However, the development of resistance is the result in many cases long-term use AAT, which is already impractical for financial reasons and due to the risk of developing a proarrhythmic effect of AAT. Therefore, we believe that RFA is indicated already when the patient agrees with its implementation, and the first prolonged paroxysm of AFL is an absolute indication for RFA.

Atrial flutter refers to severe heart failure. The rhythm is restored in most cases on its own, but sometimes medical assistance is required. Gradually disturbed hemodynamics (blood flow) and an increased load on the heart lead to the development of heart failure, the formation of blood clots and other complications that worsen the patient's quality of life. In the treatment of atrial flutter, surgery is often used, especially if clinical picture gradually increases, despite taking medications.

Flutter is a description of the main symptom characteristic of this type of arrhythmia. The atria contract rapidly, at a speed of up to 250 times per minute, receiving an impulse from the focus of replacing (ectopic) signals. It is localized in the supraventricular space, mainly in the lower part of the left atrium. Against the background of flutter, blockade of the atrioventricular node is manifested. When the mark of 400 beats per minute is reached, we are talking about a ciliary form of failure (atrial fibrillation). Both stages of the development of arrhythmia are closely interconnected, therefore the words "flutter", "fibrillation" and "flicker" are used by many as synonyms for one pathological process. It is extremely problematic to identify it on an ECG (electrocardiogram) due to its chaotic manifestation.

The ICD (International Classification of Diseases) code for atrial flutter is assigned I48. It is used by doctors when making a diagnosis and writing a conclusion in medical forms. To ordinary people there is no need to know the decoding of this information.

Causes

The main criterion (sign) of atrial fibrillation is a chaotic high-frequency contraction. It occurs for the most part through the fault of organic lesions of the heart muscle caused by various pathological processes. You can check them out below:

• rheumatism;
• ischemia;
• cardiomyopathy;
• sinus node dysfunction syndrome;
• myocardial infarction;
• chronic obstructive pulmonary disease;
• inflammatory diseases;

• atherosclerosis;
• myocardial dystrophy;
• hypertension;
• Wolff-Parkinson-White syndrome;
• emphysema;
• thromboembolism.

Among other reasons, non-cardiac factors that affect the development of atrial flutter can be distinguished:

• diabetes;
• intoxication of various origins;
• sleep apnea (short-term cessation of breathing during sleep);
• hypokalemia (low potassium levels);
• hyperthyroidism (hyperactivity of the thyroid gland).

The following factors can become a trigger (trigger) for an attack:

• weather;
• physical and mental overload;
• stress;
• plentiful drink;
• malfunctions of the gastrointestinal tract;
• the use of alcoholic beverages.

When diagnosing, hereditary predisposition is not excluded, especially if it is not possible to identify the causative factor. In such cases, we are talking about an idiopathic (indefinite) form of arrhythmia.

Development mechanism

It is customary to consider the macro-re-entry mechanism as the basis for atrial fibrillation. It is a repetitive excitation of the muscle tissues of the heart. The attack is caused by the circulation of the right atrial re-entry circle. On the one hand, it is limited by the annulus of the tricuspid valve, and on the other hand, by the vena cava and the Eustachian crest. Simply put, the impulse moves in a circle, involving in the process all nearby tissues that should not normally contract. The trigger for this failure can be atrial extrasystoles. The frequency of depolarization is 250-300 beats per minute.

The atrioventricular node cannot pass a large number of signals to the ventricle (over 200). Some impulses are blocked. Often the ratio is 2:1. In this case, if the atria contract at a frequency of 300 beats per minute, then the ventricles only 150. Sometimes the proportion is much higher (4:1, 5:1). Its changes lead to jumps in heart rate. The most dangerous ratio is 1:1. Such a frequency of contractions can provoke severe disruptions in hemodynamics and loss of consciousness.

Classification

It is customary to divide atrial flutter into 2 main types:

• typical shape considered the most common failure option. A wave of excitation passes through the right atrium. The number of contractions varies from 200 to 300. Most of the contraction is counterclockwise (around the tricuspid valve). Only in every 10 patients the process occurs in the opposite direction.
• An atypical variety is characterized by a wave of excitation that does not pass in the usual circle. She moves around mitral valve and mouths of the hollow veins. Distinctive feature of this form is the inability to eliminate its attack with transesophageal pacing.

According to the duration of the attack, atrial fibrillation is divided into the following forms:

• The paroxysmal variety is manifested by attacks that last no more than 1 week. Their occurrence is chaotic. Restoration of the usual sinus rhythm occurs within 2 days. You can stop the paroxysm medical methods(drug and electropulse therapy).

• The persistent form of flutter can last more than 7 days. Without medical care the rhythm will not return. In order for the arrhythmia to stop persisting (permanently staying), certain drugs and electrical cardioversion are used.
• Constant flutter is a long-term failure that has been unsuccessfully stopped or not treated at all. Surgery is often used as a therapy.

Failure symptoms

The intensity and frequency of attacks of atrial flutter depends on the form and causative factor of the arrhythmia. It is characterized by the following clinical picture:

• general weakness;
• feeling of squeezing in the chest;
• angina attacks;
• dyspnea;
• increase in pressure;
• dizziness;
• decrease in performance.

Disturbed by paroxysms of atrial flutter both once a year and 2-3 times a day. In severe cases, the patient may lose consciousness. A harbinger of this is a decrease in visual acuity, dizziness and a feeling of lack of air.

Diagnostics

If symptoms of a malfunction in the heartbeat are found, the patient should consult a cardiologist to conduct an examination and prescribe all necessary examinations. Detection of atrial flutter often occurs on the ECG. The specialist will be able to see atrial F waves with regular and unchanged ventricular complexes. For more precise setting diagnosis will need to be daily monitoring ECG to detect the relationship of failure with various factors.

Additionally, you need to pass ultrasonography hearts. The cardiologist will be able to assess the structure of the organ, its contractility and valve function. To get a more accurate picture of what is happening in the body, you will have to take blood and urine tests. They will allow you to see the level of hormones, the balance of electrolytes and exclude the presence of rheumatism.

A course of treatment

Treatment of atrial flutter should be comprehensive. It may include the following methods:

• taking medications;
• ethnoscience;

• surgical intervention;
• electropulse therapy (defibrillation);
• lifestyle modification.

The attending physician should correctly prescribe the pills and give recommendations regarding the correction of the lifestyle and methods of stopping the attack. It focuses on the age of the patient, his condition, the presence of other pathologies and the cause of the failure. With care, a treatment regimen is drawn up for the elderly, pregnant women and children.

First aid measures

Emergency care for paroxysmal atrial flutter looks like in the following way:

• In severe cases, amiodarone is administered. If the effect is not achieved, then after half an hour an injection of "Digoxin" is made. 2 hours after the onset of the attack, transesophageal electrical stimulation is performed or electrical impulse therapy is started.
• With a relatively stable condition, the patient is given a solution of magnesium and potassium, injections of "Digoxin" are made. If the treatment did not bring results, then start electropulse therapy.

In many cases, the attack can be stopped. If it nevertheless developed into a ciliary form of arrhythmia, then defibrillation has to be done.

While maintaining normal hemodynamics for prehospital stage you can switch to the use of tablets orally (through the mouth). The attack is most quickly stopped by taking "Quinidine" or "Propranolol" in combination with medicines based on potassium and magnesium.

Medical therapy

Medical treatment for atrial flutter is as follows:

• Beta-blockers ("Propranolol", "Metaprolol") reduce the frequency of contractions by reducing the effects of adrenaline.

• Calcium antagonists ("Amlodipine", "Verapamil") have a vasodilating effect, due to which the load on the heart is reduced.
• Potassium blockers ("Amiadarone", "Sotanol") slow down the electrical processes in the myocardium.
• Sodium antagonists ("Quinidine", "Propranorm") block its channels, which leads to inhibition of the excitability wave and the cessation of arrhythmia.
• Cardiac glycosides ("Digitoxin", "Cordigit") reduce the frequency of contractions, reducing the conductivity of the atrioventricular node.
• Anticoagulants ("Heparin", "Clexane") are prescribed as a means of preventing the formation of blood clots.
• Magnesium and potassium preparations ("Asparkam", Doppelherz Aktiv) improve neuromuscular transmission, normalize blood pressure and stabilize the conduction of impulses.

With the development of the Wolff-Parkinson-White syndrome, conduction failures appear along the main pathways. Doctors prescribe only anticoagulants and drugs that block potassium and sodium. Other medicines are contraindicated or ineffective.

Electropulse therapy

Electropulse therapy for atrial flutter is carried out with the ineffectiveness of medications and the rapid aggravation of the condition. Its essence lies in the application of current on the chest to depolarize the heart muscle and return to sinus rhythm.

• glycoside intoxication;
• sinus arrhythmia;
• a constant kind of atrial flutter;
• inflammatory processes in the heart muscle.

Surgical intervention

Treatment by surgery is recommended in the absence of a result after taking medications and aggravation of hemodynamic disorders. Radiofrequency ablation is usually performed, the essence of which is cauterization ectopic focus or a pacemaker is installed as an artificial pacemaker. In both cases, the operation is performed by the surgeon, guided by generally accepted standards and algorithms of actions.

You can see how radiofrequency ablation is performed below:

• pierced under local anesthesia femoral artery and the catheter is inserted. The doctor delivers it directly to the necessary section of the heart muscle.
• Using an electrophysiological study, the specialist finds the exact location of the focus of ectopic impulses and cauterizes it.

The pacemaker is installed as follows:

• Under local anesthesia a subclavian vein is punctured. Through it, electrodes are inserted into the necessary parts of the heart.
• Then an incision is made in the skin chest muscle and install the device. The opposite sides of the wires are connected to it.

ethnoscience

Facilities traditional medicine cannot eliminate the causative factor, but are able to supplement the main therapy regimen. With their help, the patient will saturate the body with useful substances and soothe nervous system. The most relevant recipes are:

• Pour 30 g of calendula buds with 500 ml of boiling water and close the container with a lid. After 2-3 hours, remove the raw material. Drink an infusion of 120 ml at least 3-4 times a day.
• Mix 1:1 tincture of hawthorn and propolis. Take the resulting mixture in 0.5 tsp. 3 times a day.
• Combine in equal proportions the juices of beets, carrots and radishes. It is recommended to drink the finished drink every day for 1-2 glasses for several months.

Complications

Atrial flutter and its accompanying manifestations exhaust the heart muscle. Gradually, the patient may develop the following complications:

• ventricular forms of arrhythmia;
• stroke;
• asystole (cardiac arrest);
• myocardial infarction;
• thromboembolism;
• occlusion (obstruction) of blood vessels;
• heart failure.

Forecast and prevention

Atrial flutter is quite resistant to antiarrhythmic drugs and has a tendency to relapse, which often develop into atrial fibrillation. At long course failure increases the likelihood of developing life-threatening complications. You can improve the prognosis by visiting a cardiologist, following his recommendations and following the prevention rules drawn up by the national institutes of health. They are listed below:

• engage in the treatment of primary pathologies;
• avoid stressful situations;
• play sports at a moderate pace;
• to refuse from bad habits;
• stop consuming caffeine and energy drinks;
• avoid physical and mental overload;
• take prescribed medications;
• regularly undergo the necessary examinations;
• get enough sleep (at least 7-8 hours a day).

Therefore, atrial flutter is a dangerous form of arrhythmia that can get worse and cause complications. It is necessary to engage in treatment when its first signs are detected in order to avoid surgical intervention. If you follow all the recommendations of the doctor, take the prescribed medications and get examined regularly, you can improve the quality of life and prevent dangerous consequences.

Article publication date: 03/01/2017

Article last updated: 12/18/2018

From this article you will learn: what is atrial flutter, what is the mechanism of its occurrence. What factors contribute to the development of pathology, its diagnosis, treatment and prevention.

Atrial flutter is an arrhythmia characterized by rapid but rhythmic atrial contractions. It is less common than fibrillation (accelerated chaotic contractions). Such arrhythmia affects only 0.09% of people worldwide, while fibrillation occurs in 3% of the population.

The disease proceeds in the form of seizures. There is treatment aimed at relieving an attack that has already begun (paroxysm), as well as at reducing the frequency and preventing recurrence of attacks. There are also radical methods that help to permanently get rid of the disease.

To prescribe treatment, contact a cardiologist or arrhythmologist.

What happens with atrial flutter

This arrhythmia occurs due to a violation of the conduction of an impulse in the heart.

Normally, the impulse spreads through the heart in this way:

1. Formed in sinus node, which is located at the top of the right atrium.
2. From there it is simultaneously carried out to: cardiomyocytes ( muscle cells- when the impulse reaches them, they contract) of the right atrium, through the Bachmann bundle to the cardiomyocytes of the left atrium and along the internodal conduction tracts to the atrioventricular node, which is located below the right atrium. That is, at this stage, they are reduced right atrium and the left atrium, as well as the impulse reaches the atrioventricular node.
3. Through the atrioventricular node, the impulse is transmitted to the conduction system of the ventricles: to the bundle of His, its legs, then to the Purkinje fibers and then to the ventricular cardiomyocytes. The atrioventricular node is unable to conduct an impulse with high speed. This is necessary to delay the impulse so that the systole (contraction) of the ventricles occurs only after the end of the atrial systole.

With atrial flutter, the course of the impulse along the atrial conduction system is disrupted. It begins to circulate in the right atrium in a circle. Because of this, repeated re-excitation of the atrial myocardium occurs, and they contract at a frequency of 250 to 350 beats per minute.

The ventricular rhythm may remain normal or be rapid, but not as fast as the atrial rhythm. This is explained by the fact that the atrioventricular node is not able to conduct an impulse so often and begins to conduct only every second impulse from the atria (sometimes every third, fourth or even fifth). Therefore, if the atria are contracting at a rate of 300 bpm, the ventricular rate may be 150, 100, 75, or 60 bpm.

The exception is patients with WPW syndrome. Their heart contains an additional, abnormal bundle (Kent's bundle), which can conduct impulses from the atrium to the ventricle faster than the atrioventricular node. Therefore, atrial flutter in such patients often entails ventricular flutter.

Causes of atrial flutter

Arrhythmia occurs on the background or as postoperative complication(usually in the first week after cardiac surgery).

What can provoke an attack in people prone to atrial flutter:

heat;

stress;

alcohol or drug use.

Sometimes paroxysms appear under the influence of these negative factors, and sometimes spontaneously.

Symptoms

The attack develops suddenly. During it, the patient feels strong heartbeat or discomfort in the area of ​​the heart. Often patients describe their sensations as "interruptions" in the work of the heart, the heart "rumbles", "jumps out of the chest."

Also, paroxysm is accompanied by weakness, dizziness, reduced pressure, sometimes - shortness of breath.

Sometimes atrial flutter is asymptomatic (especially if the ventricular rate is normal). But treatment is still necessary, as this arrhythmia can lead to dangerous complications.

Possible Complications

The most common:

The last two arrhythmias are very dangerous and can be fatal.

Atrial flutter impairs blood circulation (hemodynamics) in coronary vessels resulting in insufficient blood supply to the myocardium. This can cause a microinfarction, heart attack or sudden stop hearts.

Frequent attacks lead to the development of chronic heart failure.

Also, repeated paroxysms of atrial flutter increase the risk of blood clots, which can lead to:

• blockage pulmonary artery;
• blockage of the vessels of the abdominal cavity;
• blockage of the vessels of the extremities;
• stroke.

Diagnostics

It consists of 3 stages:

1. Initial examination of the patient: the doctor records the patient's complaints, collects an anamnesis, measures heart rate and pressure.
2. ECG: with its help, pathology can be detected. Sometimes prescribed (daily ECG).
3. Further examination and determination of the causes of arrhythmia. At this stage, the patient may be prescribed (ultrasound of the heart), biochemical analysis blood, transesophageal echocardiography, transesophageal electrocardiography.

Initial inspection

During an attack, the pulse on the hands may be normal (60-90 beats / min) or quickened (up to 150 beats / min). The pulsation of the jugular veins is usually accelerated and corresponds to the frequency of atrial contraction. The pressure may be reduced.

ECG

There are no P waves on the ECG. Instead, there are sawtooth F waves preceding the ventricular beats. The latter are not changed and do not have deviations from the norm. In front of each ventricular complex is the same number waves F (2, 3, 4 or 5).

Atrial flutter on ECG

Changes on the cardiogram are visible only during an attack. But since the paroxysm can last for a long time, fix it with conventional ECG is quite real.

If atrial flutter occurs frequently, but the attacks are short-lived, Holter monitoring is prescribed - an ECG using a portable device during the day to "catch" the time of the paroxysm.

Further examination

To prescribe adequate treatment, it is necessary to identify the cause of the arrhythmia.

For this, echocardiography is used. With this method, heart defects can be diagnosed.

They also do a blood test.

• thyroid hormones - to detect elevated levels of thyroid hormones (hyperthyroidism);
• on electrolytes - to diagnose a lack of potassium in the body (hypokalemia);
• on rheumatoid factor - to detect rheumatism (it often becomes the cause).

Transesophageal echocardiography is indicated in patients with frequent attacks to check for blood clots in the heart.

Transesophageal electrocardiography helps to establish the exact mechanism for the development of arrhythmia (exactly how the impulse circulates through the atrium).

How to get rid of the disease

Currently, an effective therapy has been developed to relieve attacks of atrial flutter, but this arrhythmia is difficult to cure completely - in many patients, paroxysms reappear. In such cases, radical treatment is used, which helps to eliminate the disease forever in 95% of cases.

It is also worth noting that in addition to treating the arrhythmia itself, the underlying disease that contributed to its appearance is also treated.

More about medication and non-drug treatment atrial flutter itself, read on.

Medical treatment of paroxysm

It is carried out in 2 stages:

1. First, lower the heart rate with beta-blockers (Metoprolol and others) or blockers calcium channels(Diltiazem, Verapamil).
2. Then others are introduced (Amiodarone, Sotalol, Ibutilide) to completely eliminate the rhythm disturbance.

Other methods of stopping an attack

These include:

• Transesophageal pacing (TEPS) is the elimination of arrhythmia with the help of a special pacemaker, which is inserted through the esophagus.
• Electrical cardioversion - recovery correct rhythm by applying an electric discharge to the region of the heart.

Long-term drug treatment

Beta-blockers or calcium channel blockers may be prescribed to prevent a relapse.

To avoid the formation of blood clots, warfarin or aspirin is used.

Radical Methods

If drug treatment does not help, and the arrhythmia still recurs, prescribe (destruction by radio frequencies) or cryoablation (destruction-freezing) of the pathways through which the impulse circulates during an attack.

cryoablation

A pacemaker is also installed, which sets the heart to the correct rhythm.

Prevention

If you are at risk (see table "Heart conditions that cause atrial flutter" and "Factors that increase the risk of developing this arrhythmia" in the "Causes" section), be sure to adhere to the following rules:

1. Give up bad habits, as well as the use of coffee, strong tea and energy drinks.
2. Consult your doctor and choose a regimen physiotherapy exercises considering the state of the cardiovascular system. You may be advised to walk more or do special exercises.
3. Avoid potassium deficiency in the body. Eat more products rich in this macronutrient. Potassium is found in dried apricots, prunes, nuts, raisins, seaweed, legumes, tomatoes, oatmeal, carrots, bananas, kiwi, grapes, beets, avocados, milk, beef, lean fish.

If you have heart failure and have been prescribed diuretics, please contact Special attention at this point, since diuretics remove potassium from the body. But do not overdo it, as an excess of this element can also cause problems with cardiovascular system and with kidneys. Before adjusting your diet, consult with a specialist and, if possible, take a blood test for potassium.

The same rules apply to those who have already experienced this unpleasant phenomenon like atrial flutter. If the attack was successfully stopped, take all the medicines prescribed by your doctor and follow preventive measures to prevent a recurrence of the disease.

Description

atrial flutter- tachyarrhythmia with the correct frequent (up to 200-400 per 1 min.) Atrial rhythm. Atrial flutter is manifested by paroxysmal palpitations lasting from a few seconds to several days, arterial hypotension, dizziness, loss of consciousness. To detect atrial flutter, clinical examination, ECG in 12 leads, Holter monitoring, transesophageal electrocardiography, rhythmography, ultrasound of the heart, EFI. Atrial flutter is treated with drug therapy, radiofrequency ablation, and atrial pacemaker. Learn More Atrial Flutter atrial fibrillationAtrial flutter - treatment in Moscow

Atrial flutter is a supraventricular tachycardia characterized by an excessively fast but regular atrial rhythm. Along with atrial fibrillation (fibrillation) (frequent, but irregular, erratic atrial activity), flutter refers to varieties of atrial fibrillation. Atrial fibrillation and flutter are closely related and can alternate, mutually replacing each other. In cardiology, atrial flutter is much less common than atrial fibrillation (0.09% versus 2-4% in the general population) and usually occurs in the form of paroxysms. Atrial flutter is more common in men over 60 years of age.

Causes of atrial flutter

In most cases, atrial flutter occurs against the background of organic diseases hearts. The causes of this type of arrhythmia can serve as rheumatic heart disease, coronary artery disease (atherosclerotic cardiosclerosis, acute myocardial infarction), cardiomyopathy, myocardial dystrophy, myocarditis, pericarditis, hypertension, SSSU, WPW-syndrome. Atrial flutter can complicate the course of the early postoperative period after cardiac surgery for congenital heart defects, coronary artery bypass grafting.

Atrial flutter also occurs in patients with COPD, pulmonary emphysema, and pulmonary embolism. With cor pulmonale, atrial flutter is sometimes accompanied by end-stage heart failure. Risk factors for atrial flutter that are not associated with heart pathology can be diabetes mellitus, thyrotoxicosis, syndrome sleep apnea, alcohol, drug and other intoxications, hypokalemia.

If atrial tachyarrhythmia develops in a practically healthy person for no apparent reason, they speak of idiopathic atrial flutter. The role of a genetic predisposition to the occurrence of atrial fibrillation and flutter is not excluded.

The pathogenesis of atrial flutter

The basis of the pathogenesis of atrial flutter is the macro-re-entry mechanism - multiple re-excitation of the myocardium. A typical paroxysm of atrial flutter is due to the circulation of a large right atrial circle of re-entry, which is bounded anteriorly by the tricuspid annulus and posteriorly by the Eustachian crest and vena cava. Short episodes of atrial fibrillation or atrial extrasystoles can act as trigger factors necessary for the induction of arrhythmia. At the same time, there is a high frequency of atrial depolarization (about 300 beats per minute).

Since the AV node is unable to pass impulses of this frequency, only half of the atrial impulses are usually conducted to the ventricle (2:1 block), so the ventricles contract at a rate of about 150 bpm. in a minute. Much less often, blocks occur in a ratio of 3:1, 4:1 or 5:1. If the conduction coefficient changes, the ventricular rhythm becomes irregular, which is accompanied by an abrupt increase or decrease in heart rate. An extremely dangerous ratio of atrioventricular conduction is a ratio of 1:1, manifested by a sharp increase in heart rate up to 250-300 beats. per minute, decrease cardiac output and loss of consciousness.

Classification of atrial flutter

There are typical (classic) and atypical variants of atrial flutter. With the classic version of atrial flutter, the circulation of the excitation wave occurs in the right atrium in a typical circle; at the same time, a flutter frequency of 240-340 per minute develops. Typical atrial flutter is isthmus-dependent, i.e., it can be stopped and restored to sinus rhythm using cryoablation, radiofrequency ablation, transesophageal pacing in the region of the cavo-tricuspid isthmus (isthmus) as the most vulnerable link in the macro-re-entry loop.

Depending on the direction of the circulation of the excitation wave, two types of classic atrial flutter are distinguished: counterclockwise - the excitation wave circulates around the tricuspid valve counterclockwise (90% of cases) and clockwise - the excitation wave circulates clockwise in the macro-re-entry loop (10% of cases ).

Atypical (isthmus-independent) atrial flutter is characterized by the circulation of an excitation wave in the left or right atrium, but not in a typical circle, which is accompanied by the appearance of waves with a flutter frequency of 340–440 per minute. Taking into account the place where the macro-re-entry circle is formed, right atrial (multicycle and upper loop) and left atrial isthmus-independent atrial flutter are distinguished. Atypical atrial flutter cannot be treated with TPEX due to the absence of a slow conduction zone.

From the point of view of the clinical course, atrial flutter developed for the first time, paroxysmal, persistent and permanent form. Paroxysmal form lasts less than 7 days and stops on its own. The persistent form of atrial flutter has a duration of more than 7 days, while self-restoration of sinus rhythm is impossible. A permanent form of atrial flutter is spoken of if medical or electrical therapy has not brought the desired effect or has not been carried out.

The pathogenetic significance of atrial flutter is determined by the heart rate, on which the severity depends clinical symptoms. Tachysystole leads to diastolic and then systolic contractile dysfunction of the left ventricular myocardium and the development of chronic heart failure. With atrial flutter, there is a decrease in coronary blood flow, which can reach 60%.

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What it is?

Atrial flutter is called frequent atrial contraction up to 400 per minute while maintaining the correct regular rhythm. Frequent impulses are accompanied by partial blockade of the atrioventricular region, and they lead to a rare ventricular rhythm.

An attack of atrial flutter is a paroxysm lasting from a few seconds to several days. Due to the instability of the rhythm, there is a transition to sinus rhythm or atrial fibrillation, which occurs more often. The patient has all three phenomena in turn, but rarely can develop a stable or permanent form of the disease.

Atrial flutter can only be detected through complex diagnostics and after long-term monitoring of the patient's condition. Symptoms are absent in most cases.

Types of flutter

There is no division into paroxysmal and constant atrial flutter, but it is divided into types. There are two types of atrial flutter:

• atypical;
• typical.

The atypical view is distinguished by the movement of the impulse in the right or left atrium, but the process does not affect the tricuspid valve. Such flutter occurs against the background of heart operations.

A typical manifestation of atrial flutter occurs with the accelerated movement of an electrical impulse around the right atrial valve. The pathology can be eliminated only by ablation. The procedure is not complicated, but requires professionalism and experience from a specialist.

Causes

There are many reasons for the appearance of atrial flutter and not all are directly related to the work of the cardiovascular system. In some cases, a person does not have other diseases, and an attack of flutter occurs. It concerns hereditary factor if there was a family history of heart disease, then the risk of occurrence increases several times.

Diseases of the cardiovascular system can provoke atrial flutter:

• various heart defects;
• ischemia;
• arterial hypertension;
• inflammatory processes of the membranes of the heart;
• heart failure;
• open heart surgery.

In addition to heart disease, atrial flutter can cause other serious disorders:

• endocrine diseases, in particular, diabetes mellitus and thyrotoxicosis;
• overweight;
• chronic pulmonary dysfunction.

Symptoms

Symptoms of the disease depend on the form of its course. Each of them has its own differences and manifests itself in different ways, but to some extent they are very similar.

Paroxysmal type

Atrial flutter occurs at different intervals and lasts in different ways. During the year, a person may experience single attacks or daily paroxysms up to 2-3 per day. They occur in both men and women, age criteria also do not exist, but occur more often in men old age or if cardiovascular diseases are present.

Atrial flutter is associated with emotional and general physical condition person. The following factors provoke an attack:

• bad habits;
• stress;
• physical exercise;
• fluctuations in body temperature;
• excess fluid;
• digestive disorders.

Palpitations are the main symptom of paroxysmal atrial flutter, but it can be confused with temporary overexertion. In the hope that everything will go away on its own, a person misses an important point and ignores the symptoms. If treatment is not started before the first complications appear, then surgery is indispensable, and the myocardium and other membranes will be irreparably damaged. A high frequency of contractions leads to a number of characteristic symptoms:

• dizziness;
• fever
• loss of consciousness;
• transient cardiac arrest.

Such a dangerous manifestation severe symptoms without treatment, they will end in serious consequences for the body or death.

Steady type

This dangerous form diseases on initial stage does not appear. The first symptoms occur when the effects of a pressure surge lead to a decrease in blood flow in the coronary arteries. Patients usually see a doctor when symptoms of heart failure occur.

Diagnostics

To prevent possible complications and consequences, it is important to diagnose such a violation in time. Since atrial flutter always occurs suddenly, and the attack itself does not last long, it is not so easy to get ahead of the violation. There are several methods for monitoring heart rate and contractions:

• electrocardiography (ECG);
• research according to the Norman Holter method;
• electrophysiological study.

Most often, if there are suspicions of abnormalities in the functioning of the cardiovascular system, an ECG is used for diagnosis. With the help of a special apparatus of an electrocardiograph, the potential difference that occurs on the surface is recorded. skin during the work of the heart muscle.

The ECG method has been used for more than 100 years, and over the years the device itself has been improved, and the specialists conducting the procedure were able to thoroughly study all the nuances of the study. Modern ECG devices have become more accurate, compact and advanced. Progress allows, conducts ECG study even at home, which is very convenient for atrial flutter. You can catch an attack by taking a cardiogram several times a day, and in a hospital setting this is not always convenient. Most private clinics and offices offer ECG to patients at a distance using a regular landline phone.

The Norman Holter method or Holter monitoring is used to determine the frequency of paroxysms and their causes. Continuous monitoring of blood pressure and ECG indicators shows fluctuations when exposed to the heart external stimuli response to physical and mental stress. For accurate results it is important for the patient to record all his actions and feelings during the daily study.

People are often afraid of the electrophysiological examination procedure, but you should not be afraid. The examination refers to a minimally invasive procedure, during which flexible catheters with electrical contacts are sent through the veins to the heart. In this way, the rhythm and potentials are recorded directly from the chambers of the heart. With the help of the study, you can detect the pathology that led to violations, as well as accurately determine the location of myocardial damage.

Additionally, to establish an accurate diagnosis and the causes of the disease, an ultrasound examination is prescribed, which helps to determine the condition of the valves and the size of the heart. Echocardiography records myocardial contractility.

Treatment Methods

Treatment of such a phenomenon as atrial flutter depends on the patient's condition, the frequency of attacks, the presence of concomitant diseases, and individual characteristics organism. Treatment of atrial flutter is carried out by several methods, taking into account the symptoms of the disease.

With paroxysms, it is important to provide first aid to the patient in order to shorten the attack and prevent the consequences. If a person has, in addition to atrial flutter, angina pectoris, cerebral ischemia, or heart failure, then cardioversion will be needed. A discharge of up to 50 J is sufficient to restore normal sinus rhythm. For people who have undergone previous heart surgery, electrodes are often left for continuous stimulation by the intra-atrial method.

At frequent use electrical stimulation to increase the effectiveness of the chosen technique, the following drugs are used:

• disopyramide;
• novocainamide;
• ibutilide;
• flecainide.

These drugs restore sinus rhythm with frequent pacing but increase the risk of ventricular tachycardia. If atrial flutter lasts more than 2 days before cardioversion, anticoagulant therapy should be performed. In addition, constant ECG monitoring is required.

For a person prone to attacks of atrial fibrillation or atrial flutter throughout life, it is important to take drugs to prevent seizures. Pick up effective drug often not easy. To choose the safest and successful method treatment a person has to try various drugs until the desired result is achieved. Monitoring of treatment is carried out with the help of regular ECG examination.

In addition to emergency cardioversion and drug therapy, catheter ablation of the cavotricuspid isthmus is used. Only creation complete blockade is the most effective way combating atrial flutter. The procedure is safe and, most importantly, minimally invasive. It is carried out both during an attack and in normal sinus rhythm.

This method is used when habituation to constant electrical stimulations occurs and after an increase in the interval and duration of the attack. The choice always remains with the patient, but it must be remembered that cardioversion is a temporary measure, and ablation, if not forever, then for a long time, will relieve dangerous paroxysms.

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1Causes of occurrence

Atrial flutter is more common in men than in women and is more common in the elderly. Almost always, atrial flutter occurs in a heart that has organic pathology: when the patient has rheumatic or congenital heart disease, chronic heart attack or post-infarction cardiosclerosis, severe hypertension, myocarditis, heart failure.

Atrial flutter can develop in people suffering from chronic lung diseases, hyperproduction of thyroid hormones - thyrotoxicosis. Very rarely, atrial flutter is not accompanied by organic lesion heart muscle, these are rather exceptional cases, but they can occur in people who abuse alcohol. Atrial flutter can occur with digoxin intoxication, after surgery on the heart valves.

2 How does flutter develop?

The development mechanism is based on the “macro-re-entry” mechanism. Its essence is that the heart muscle is subjected to repeated excitation “in a circle”, atrial contraction provokes more and more contractions, and the excitation recirculates in the heart muscle. The AB node is located between the atria and ventricles. He is unable to pass to the ventricles such a frequent impulsation that the atria generate.

Therefore, the AB node sets up a kind of block for these impulses and passes only every second atrial impulse to the ventricles. Sometimes every third or every fourth. But more often, atrial and ventricular contractions correlate as 2:1. This prevents over-rapid ventricular contraction, which can be extremely dangerous. If all chambers of the heart contract in atrial rhythm, there is a sharp increase in heart rate, a decrease in blood flow to the heart, loss of consciousness, which can be fatal.

3Classification

Atrial flutter is classified into:

• typical,
• atypical.

In a typical form, the wave of excitation circulates in a typical circle in the right atrium. This form is recorded in 85-90% of patients, the frequency of contraction of the upper chambers of the heart is 250-350 per minute. Electrocardiographically, with a typical form in leads III, aVF, the F-waves of flutter are negative, and in V1 they are positive. The typical form is restored to a normal rhythm during pacing.

Atypical form characterized by a higher atrial rate of 340-430 per minute, this is due to the circulation of waves in both atria not in a typical circle. This transitional form between flutter and atrial fibrillation. The atypical form is resistant to pacing. According to the clinical course, there are forms of flutter:

• paroxysmal,
• permanent.

Atrial flutter, which manifests itself in the form of attacks of various durations, but not more than 7 days, is called paroxysmal. If the time of atrial flutter exceeds two weeks or more, then this form of flutter is called permanent or chronic.

4Clinical picture

Similar signs are characteristic of the paroxysmal or chronic form. But a more vivid clinical picture is observed with paroxysmal flutter. Therefore, the clinic will be considered on the example of paroxysm. It is worth noting that paroxysms can occur with different frequencies: from once a year to several times a day.

The main symptoms of paroxysm are the sudden onset of palpitations, dizziness, a feeling of lack of air, severe weakness, paroxysmal pain in the heart. If the patient has a pronounced organic cardiac pathology, signs and symptoms of flutter paroxysm may be a decrease in blood pressure, increased heart rate, blanching of the skin, cough, hemoptysis. Signs of heart failure may develop or worsen.

The severity of the clinic, symptoms and signs are more dependent on the magnitude of ventricular contractions, as well as individual tolerance atrial flutter patients. The higher the ventricular rate, the more severe the patient's condition and the more pronounced the symptoms. But cases of asymptomatic course of this form of arrhythmia are also described.

5Complications

Regardless of the severity of symptoms or clinic, atrial flutter is dangerous for its complications. This form of arrhythmia can turn into atrial and ventricular fibrillation, there is a high probability of the formation of blood clots and thromboembolism, as a result of which stroke, pulmonary embolism can develop. These states in a large percentage cases lead to death or disability.

6Diagnosis

During a medical examination, the pulse is up to 120-180 per minute, sometimes up to 300 per minute. When examining the neck area, a pulsation of the neck veins is observed, with auscultation - tachycardia, I tone can be enhanced. The main diagnostic method is the ECG. There are special ECG signs that allow diagnosing this form of arrhythmia, all health workers are familiar with them, and it is often not difficult to make an ECG diagnosis.

The main ECG signs of atrial flutter are:

• the presence on the ECG of regular, identical flutter waves F, similar to the teeth of a saw, which are well recorded in leads I, II, aVF and right chest leads;
• the same height and width of the F waves on the ECG, with a steep ascending and more gentle descending knee;
• the presence of normal, unchanged QRS complexes on the ECG, each of which is preceded by a certain number of F waves (2:1, 3:1, 4:1);
• equal R-R intervals on the ECG, but if the degree of passage of impulses through the AB node changes, the duration of the R-R intervals may also change;
• F waves pass one into the other without any interval on the ECG.

In addition to the electrocardiogram, diagnostic methods include Holter ECG monitoring (this research method allows you to fix paroxysms during the day, as well as at night), echocardiography (determines the structure of the myocardium, the state of valves, heart chambers), blood tests and thyroid hormones.

7Treatment

The goal of treatment is to stop the paroxysm, if any, control the frequency of ventricular contractions, prevent relapses and complications of flutter. The best way to stop the paroxysm of atrial flutter is electrical defibrillation. This method of treatment is recommended to be used after the diagnosis is established, without delay. Especially defibrillation is indicated for collapse, acute left ventricular failure, syncope.

Usually, a discharge of 50 kJ is sufficient to stop the paroxysm. Also, paroxysm can be stopped by transesophageal pacing. If it is not possible to produce the above methods of treatment, then the relief of the attack is carried out with medication. But it is rare to restore the rhythm during flutter after a single injection of antiarrhythmics.

To reduce the frequency of contractions of the ventricles, verapamil, diltiazem, b-blockers, cardiac glycosides are used. To reduce the risk of thromboembolism, heparin and warfarin are used. Surgical methods of treatment can be used - radiofrequency or cryoablation of the macro-re-entry focus, as a result of which its destruction occurs, these methods are used with a constant form of flutter. It is also possible to install a pacemaker.

8Folk methods of treatment

Despite the development of medicine, adherents of the treatment of arrhythmia with folk remedies remain. Physicians are of two minds about this. The use of folk remedies is not prohibited, the main thing is that patients, using this or that folk remedy, know about their side effects. And it is better before using folk remedies, consult a doctor and find out if it is right for you to use it.

Folk remedies that are common in treatment include:

• a decoction of rose hips with honey,
• melissa infusion,
• decoction of valerian roots,
• decoction of asparagus officinalis,
• infusion of herb yarrow.

It is recommended to take decoctions and infusions inside, before meals, in a course of at least 3-4 weeks. Of course, it is impossible to cure atrial flutter only with folk remedies. In combination with traditional methods treatment, treatment with folk remedies can have a restorative, sedative effect.

9Prevention

Preventive measures include timely diagnosis and treatment of cardiac pathology, normalization of body weight, cessation of smoking and alcohol consumption, sufficient physical activity, balanced diet, annual check-ups. It is much easier to prevent a disease than to cure it. Therefore, it is necessary to monitor the state of your heart, and with the slightest change in its work or your own well-being, you must visit the doctor's office.

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Causes

Atrial flutter can be caused both by a disease of the heart itself, and by diseases that affect other internal organs, which, however, affect the electrical impulses passing through the heart.
Main cardiological reasons causing TP are:

• Cardiac ischemia;
• Atherosclerosis;
• Tendency to form blood clots;
• High blood pressure;
• Different types of cardiomyopathy;
• Anomalies of the heart valves (especially mitral);
• Abnormal enlargement of the chambers of the heart (hypertrophy);
• Consequences of open heart surgery.

Diseases internal organs that can cause atrial flutter:

• An overactive thyroid gland (hyperthyroidism);
• Pulmonary embolism (when a blood clot is in a blood vessel in the lung)
• Emphysema of the lung.

Substances that contribute to atrial flutter:

• Alcohol (wine, beer, liquor, vodka);
• Drugs that cause a feeling of intoxication, diet pills, cold medicines that contain caffeine, etc.

Symptoms

It happens that atrial flutter is detected during an ECG. That is, in some cases it occurs asymptomatically. However, the vast majority of patients still experience discomfort associated with this pathology. Among them:

• Cardiopalmus;
• Dyspnea;
• Anxiety.

Sometimes atrial flutter is accompanied by:

• angina pectoris;
• Feeling weak and/or dizzy;
• Fainting.

Diagnostics

To date, the main diagnostic event to detect atrial flutter is an electrocardiogram. The examination can be both one-time and 24-hour (Holter monitoring), when a small device is attached to the body of the subject, which does not cause any particular inconvenience, which records ECG indicators during the day.
In addition to an electrocardiogram, a good diagnostic measure is an echocardiogram, a technique that uses sound waves to take a picture of the inside of the heart during a heartbeat and between beats. main goal this test is to identify problems with the heart valves, check ventricular function, and detect atrial clots (if any).

The test is safe, so it is carried out even for pregnant women when examining the fetal heart.

Treatment

The goals of AFL treatment are to control heart rate, restore normal sinus rhythm, and prevent future similar episodes that could lead to a heart attack or stroke.

Depending on the severity of the condition, the patient may be offered both therapeutic and surgery(rarely).

Drug therapy

To prevent future episodes of supraventricular tachycardia, patients are prescribed daily treatment by taking certain drugs that help keep the heart healthy.

The choice of drugs for the treatment of atrial flutter depends on the frequency of atrial fibrillation and on the general condition of the patient.

Basically, to combat supraventricular tachycardia, antiarrhythmic drugs (beta-blockers and calcium channel blockers) are used, with which it is possible to convert atrial flutter to normal sinus rhythm, reduce the frequency and duration of flutter episodes, and also prevent future attacks of flutter. Row antiarrhythmic drugs not small, but most often doctors prescribe Anaprilin, Metoprolol and Bisoprolol.

Photo gallery of antiarrhythmic drugs

To prevent the development of a stroke, it is mandatory to take anticoagulants - drugs designed to prevent stroke. That is, if a person has congestive heart failure and mitral valve disease, there is every reason to assume that at some point a brain stroke may develop. Therefore, people with constant atrial fibrillation are prescribed blood-thinning drugs: Warfarin, Heparin, etc.

Photo gallery of anticoagulants

In cases where the risk of stroke is acceptable, but it is very low, aspirin is dispensed with.

However, we should not forget that aspirin can cause gastric, intestinal, hemorrhoidal and other types of bleeding, as well as contribute to the development of stomach ulcers.

Instrumental treatment - cardioversion-defibrillation

This technique involves the use electric current, by which the heart is "shocked" and thereby returns to normal sinus rhythm.

To perform the procedure, a special device is used - a defibrillator. When the session is carried out as planned, in a hospital, then, due to the pain of the procedure, everything takes place under mild general anesthesia.

In 90% of cases, cardioversion-defibrillation works perfectly, and the heart rhythm is restored. However, 10% of patients report that the arrhythmia returns some time after the procedure.

Another disadvantage of cardio-defibrillation is the risk of stroke. Therefore, when possible, doctors prefer to treat with blood thinners some time before the procedure.

Surgical treatment - catheter ablation

The advantage of catheter ablation is its low invasiveness.

The essence of the procedure is as follows - first, the location of the arrhythmogenic focus is precisely determined, and then a catheter is inserted there - this allows you to destroy the abnormal path and ensures a uniform flow of electrical impulses.

Catheter ablation almost always goes without complications, but sometimes it is ineffective.

home treatment

People diagnosed with atrial flutter should take the medication prescribed by their doctor - this is the only treatment they should adhere to.

No stimulants medicinal herbs And food additives you can’t drink without consulting your doctor, since such “amateur activity” can result in atrial fibrillation and death of the patient.

Complications

The most serious complication, besides atrial fibrillation, which can cause atrial flutter, is stroke.

The development of a stroke, against the background of supraventricular tachycardia, occurs as follows - due to atrial flutter, the heart cannot properly pump blood, and it begins to move through the bloodstream more slowly than usual. In this scenario, the likelihood of the formation of a blood clot increases, which, once in the heart, can exfoliate into smaller clots, which, in turn, will carry the blood to the brain. If this happens, then there is a high probability of blocking one of the blood vessels of the brain, and this is fraught with a stroke.

Another serious complication of atrial flutter is heart failure. The mechanism for the development of heart failure is as follows - prolonged tachycardia weakens the heart muscle, which worsens its pumping function. And heart failure is precisely that condition when the heart cannot pump enough blood passing through blood vessels sick.

Atrial flutter, which is caused by some disease that is not accompanied by serious damage to the heart (for example, pneumonia), usually disappears after treatment of the underlying pathology and never recurs. For those who have any heart disease, atrial flutter may be dangerous state therefore, cores at the slightest suspicion of TP should contact a cardiologist.

serdcemed.ru Left ventricular hypertrophy on ecg