Thanks for this! I have congenital heart disease with single ventricle and fontan palliation. I had ablation for CTI atrial flutter. If you have an ablation, for CTI isthmus, does it permanently destroy the tissue ?
This is the best video about atrial flutter i’ve seen!! However there are 3 things I didn’t understand: 1) At 6:52 how are the P waves positive in V1 as the impulse comes from the right atrium? 2) At 7:58 how can we know that the waves in V1 are negative? I didn’t quite see an isoelectric line and they had a slow up, fast down pattern that I would’ve associated with positive waves 3) At 10:08 you said that absence of inferior sawtooth is an indication of CTI- independent, but doesn’t the reverse typical one also have positive waves in the inferior leads? Thank you in advance doctor😌
Awesome video Sir, but there must be clockwise and anticlockwise atrial flutters too.. How to recognize them if they are left atrial or right atrial.. Depending upon V1?
I know Im asking the wrong place but does any of you know a method to get back into an Instagram account..? I was stupid forgot my password. I would appreciate any assistance you can offer me.
well explained way for understanding atrial flutter sub types. I would like to hear from you effects of anti-arrhythmic effect on AFL rate and morphology. Sometimes it becomes so difficult to even distinguish from sinus rhythm for patients under amiodarone.
Hi DR. Thanks for your videos. I am a fontan patient with a single ventricle. I've had two abaltions for CTI atrial flutter. I don't understand why the CTI and scaring causes slow impulse conduction but that then causes a rapid heart rate in an arrythmia. Do you know why?@StrongMed
Dr. Strong, I had an EKG the other day that the cardiologist read as 2:1 atypical aflutter. I was always told that 2:1 aflutter would typically have a heart rate of 150. This guy was 120-130 all night. Why is this different in atypical aflutter?
It is true that typical atrial flutter most commonly has as flutter rate of ~300 "flutter waves" per min, resulting in an overall ventricular rate of ~150 bpm when in 2:1 block. However, there are a number of different reasons that flutter rates can vary from this. One mentioned in the video is the concurrent use of antiarrhythmics, most commonly seen with class Ic drugs. Also, the physical length of the flutter circuit plays a role. For example, the flutter rate in typical flutter in patients with right atrial enlargement can be as slow as 240/min, resulting in a ventricular rate of ~120 bpm when in 2:1 block. With atypical flutters, there are all kinds of different reentry circuits - some larger, some smaller than the isthmus-dependent typical flutter - resulting in a variety of rates. The presence of electrolyte and pH disturbances as well as profound hypoxemia can also theoretically impact flutter rates as well.
