585
edits
Tachycardia: Difference between revisions
Jump to navigation
Jump to search
→Atrial Flutter
| Line 36: | Line 36: | ||
An AFT is usually paroxysmal, with a sudden onset, and is diagnosed on the ECG by it typical sawtooth pattern and atrial frequency. Patients experience complaints of palpitations, dyspneu, fatigue or chest pain. An AFT has a frequency of 300 bpm, which conducts to the ventricles in 2:1, 3:1 or 4:1 manner. The P-wave morphology has a sawtooth like appearance and in a typical AFT has a negative vector in the inferior leads. The first part of the P-wave is fast, the second path slow. In a atypical AFT the inferior leads have a positive vector. Atrial fibrillation is a common finding in patients with an atrial flutter (up to 35%). | An AFT is usually paroxysmal, with a sudden onset, and is diagnosed on the ECG by it typical sawtooth pattern and atrial frequency. Patients experience complaints of palpitations, dyspneu, fatigue or chest pain. An AFT has a frequency of 300 bpm, which conducts to the ventricles in 2:1, 3:1 or 4:1 manner. The P-wave morphology has a sawtooth like appearance and in a typical AFT has a negative vector in the inferior leads. The first part of the P-wave is fast, the second path slow. In a atypical AFT the inferior leads have a positive vector. Atrial fibrillation is a common finding in patients with an atrial flutter (up to 35%). | ||
====Management:==== | ====Management:==== | ||
In a acute episode a patient with an AFT requires cardioversion. This can be achieved with anti-arrhythmic drugs or electrical cardioversion. Vagal | In a acute episode a patient with an AFT requires cardioversion. This can be achieved with anti-arrhythmic drugs or electrical cardioversion. Vagal maneuvers increase the AV-block on the ECG and demonstrate the AFT more clearly. Anti-arrhythmic drugs are modestly effective in the acute setting (ibutilide or dofetilide), but have the risk of pro-arrhythmic effects. . DC cardioversion is an effective methods to cardiovert AFT, especially in patients with heart failure or hemodynamic instability. AFT is amendable to catheter ablation and this is the treatment of choice in AFT. Targeted ablation of the area between the inferior vena cava and the tircuspid annulus can block the re-entry circuit. This is a very successfull procedure, with few complications in the hands of an experiences electrophysiologist. If patients are not eligible for ablation, anti-arrhythmic drugs can be started. However they are of limited efficacy and class IC drugs not be administered without AV-nodal slowing agent because of atrial slowing can result in 1:1 AV conduction. Patients with AFT require anti-coagulation as in atrial fibrillation according to the CHADSVASc score | ||
===Atrial Fibrillation=== | ===Atrial Fibrillation=== | ||