Atrial flutter is an organized macro-reentrant tachycardia with discrete regular atrial activity on ECG, usually with a rate of 250/min to 300/min. Typical atrial flutter is characterized electrocardiographically by a sawtooth pattern with inverted flutter waves in leads II, III, and aVF and positive flutter waves in lead V1 (Figure 14). Typical atrial flutter is the result of counterclockwise reentry around the tricuspid annulus. In atypical flutter, the circuit can travel in a clockwise direction or can occur in other locations in the right and left atria. Atypical flutter may occur after ablation or after congenital or valvular cardiac surgery.
Management of atrial flutter is similar to atrial fibrillation management; however, a rhythm control strategy is favored in atrial flutter because rate control may be difficult and often requires high doses of more than one AV nodal blocker. Catheter ablation is the definitive treatment for typical atrial flutter, owing to a very high success rate (>95%) and low complication rate. Oral anticoagulation in patients with atrial flutter is approached in the same manner as in patients with atrial fibrillation.