Atrial flutter: types and symptoms, first aid, treatment and prognostic assessments. One of the forms of heart rhythm disturbance is atrial flutter: signs, diagnosis and treatment ECG atrial flutter

Atrial fibrillation is the second name for atrial fibrillation, one of the most common heart ailments. It occurs in both the elderly and young people, but the risk of the disease increases with age due to common organic lesions of cardio-vascular system.

According to statistics, people over 60 suffer from AF several times more often. This disease is not considered deadly or extremely dangerous, but it can lead to a number of serious complications.

Atrial fibrillation is one of the most common types. A healthy heart beats at a rate of 60-90 beats per minute. The heart rate is controlled by an impulse sent by the sinus node. In AF, multiple impulses are sent to the heart muscle at the same time, which causes the atria to contract at a rate of up to 700 beats per minute. With such a contraction of muscle tissue, blood cannot enter the ventricles, from where it is distributed through the arteries and tissues.

Atrial fibrillation does not manifest itself in the form of rhythm and heart rate disturbances. Diagnosis includes several methods of examination.

The causes of this common pathology can be many:

1. . With a heart attack, the blood supply to the myocardium is cut off, as a result of which part of the muscle tissue dies and is replaced by scar tissue. Complications of this pathology depend on the severity of the patient's condition and the amount of damaged tissue. and atrial fibrillation are among the most frequent consequences heart attack.
2. . In cardiosclerosis, necrotic processes in the myocardium occur various reasons which are difficult to determine. The essence of this disease is that scar tissue grows in the muscle and reduces the contractility of the heart. Atrial fibrillation can be both a sign and a consequence of cardiosclerosis.
3. . With high blood pressure, the load on the heart and blood vessels becomes greater, which leads to complications such as tachycardia, angina pectoris and atrial fibrillation.
4. thyrotoxicosis. Hormones thyroid gland regulate the work of all internal organs including the heart. If the level of hormones is pathologically high, then the contractility of the heart muscle increases.

In addition to the causes, there are also provoking factors, such as stress, bad habits, long term medicines that affect the cardiovascular system, alcohol abuse, sedentary lifestyle and obesity, diabetes.

Signs and varieties

AF can manifest itself in different ways: in the form of seizures or be permanent. The manifestations of the disease largely depend on the stage and severity of its course.

Mild forms of the disease may be asymptomatic. In other cases, the patient feels an attack, a strong, painful heartbeat, chest pain, general weakness, dizziness, fainting, shortness of breath, a feeling of sudden lack of air, panic fear.

An attack of AF can last quite a long time and not disappear without medical intervention. In some cases, uncontrolled urination is also observed.

There are the following types of atrial fibrillation:

• By the duration of manifestations. Paroxysmal AF lasts from 2 days to a week. It can go away on its own or after medication. Persistent AF is accompanied by longer attacks (more than a week), the disease requires treatment. Chronic atrial fibrillation lasts constantly, and the heart rhythm cannot be restored.
• type of arrhythmia. Distinguish between atrial fibrillation and flutter. When flickering, the impulse is distributed unevenly throughout the myocardium, causing the fibers of the heart muscle to contract quickly and chaotically. In this case, the contractions of the ventricles will be unproductive. With flutter, the contraction of the fibers is slower, so this form of AF is considered milder, but the pumping function of the heart is still impaired.
• By heart rate. There are tachysystolic arrhythmia (heart rate more than 90 beats per minute), normosystolic (heart rate does not increase much, from 60 to 100 beats per minute), bradysystolic (heart rate is reduced, does not reach 60 beats per minute).

In some cases, AF is discovered incidentally during the examination, although the patient did not feel any characteristic symptoms. One of the clear signs of atrial fibrillation is a partial pulse. In the case when the heart rate is so high that it exceeds the pulse, it may not be detected at all.

AF on ECG

If atrial fibrillation is suspected, an examination in the form of a blood test and an ECG is first prescribed. is a painless and non-invasive way to check the work of the heart, its rhythm and heart rate. The procedure is carried out using electrodes that are attached to the patient's body.

The reliability of the result depends on the preparation of the patient (lack of stress and physical activity before the examination), as well as from the professionalism of the doctor who deciphers the electrocardiogram. To exclude an erroneous result the day before, it is not recommended to take alcohol and eat fatty foods. Overeating also affects the heart, so an ECG is done after a light breakfast or on an empty stomach.

Caffeine can enhance the work of the heart, so you should give up strong tea and coffee before visiting the ECG room.

Among the signs of atrial fibrillation on the ECG are:

• The appearance of teeth F. The appearance of uncharacteristic for healthy person F waves indicate a violation of the heart. On the cardiogram, these teeth are displayed as small waves that appear at different frequencies and have different amplitudes.
• Absence of a P wave. P waves are present on the electrocardiogram of a healthy person, but in AF they are absent and are replaced by F waves.
• Changed heart rate. This is expressed in the irregularity of the QRS complexes, which are indicators of the ventricular rhythm.
• The ratio of the coefficients (the number of atrial waves that are visible on the ECG) is also taken into account. With fibrillation, the coefficient is odd.

The prognosis of the disease is not unambiguous and depends on the severity of the course of the disease, the effectiveness of treatment, individual characteristics organism.

Despite the fact that the disease itself is not considered fatal, its presence in the anamnesis increases the risk of death from cardiovascular pathologies.

If thrombosis also occurs in AF, the prognosis worsens, as the risk of myocardial infarction increases. With timely and proper treatment, the installation of a pacemaker can significantly improve the patient's quality of life.

Treatment and possible complications of pathology

If the disease is asymptomatic, there is no need for medical treatment. Enough preventive measures and regular monitoring. In this case, atrial fibrillation can go away without treatment and complications.

Treatment for AF includes:

1. Drugs for the prevention of thrombosis. Blood clots are dangerous because they can break off and block a vital artery. With atrial fibrillation, drugs are prescribed to thin the blood. As a rule, these are Aspirin and Heparin. However, they must be taken with caution due to the high risk of developing side effects in the form of bleeding.
2. Preparations for normalization heart rate. These medicines help bring the heart rate back to normal and normalize the rhythm. These include Propafenone and Amiodarone. The effect of the drug begins within an hour after ingestion.
3. Beta blockers. These drugs lower the heart rate to right level, and also normalize . They help to significantly extend the life of patients who have already developed a complication in the form. However, a contraindication for admission is bronchial asthma, since beta-blockers can provoke bronchospasm.

If medical treatment does not help, the doctor will recommend a pacemaker, which, with the help of electrical impulses, will act on the atria and ventricles, causing them to contract in the desired rhythm.

More information about atrial fibrillation can be found in the video:

If left untreated, patients are at risk for development. Since the blood in the atria stagnates due to a decrease in their contractile function, the risk of blood clots increases. This can lead to a heart attack or stroke.

A frequent complication of atrial fibrillation is chronic heart failure. Due to disruption of the heart, it cannot pump blood around the body, which leads to an increase in the symptoms of heart failure: heart cough, shortness of breath, swelling, fluid accumulation in the lungs.

Atrial fibrillation refers to uneven contraction of atrial muscle fibers due to the presence of chaotic electrical activity. This type pathology of the heart rhythm is quite common in the practice of a doctor of any specialty.

The etiology of atrial fibrillation can be:

• primary(idiopathic), which occurs at a young age;
• secondary(against the background of already existing pathology in the body).

Most common causes Atrial fibrillation is a disease of the cardiovascular system that patients already have in their history. These diseases include:

• arterial hypertension (idiopathic or symptomatic);
• ischemic heart disease (postinfarction cardiosclerosis, early period myocardial infarction);
• congenital and acquired (as a result of infective endocarditis, acute rheumatic fever etc.) heart defects.

As a result of myocardial remodeling (compensation according to the hypertrophic type), excitation waves can circulate for a long time through individual muscle fibers.

Atrial fibrillation often occurs in patients with:

• thyroid diseases (especially accompanied by increased production of thyroid hormones, which subsequently leads to tachycardia);
• COPD (gradually there is an increase in pressure in the pulmonary circulation and a chronic pulmonary heart is formed).

The risk of this type of arrhythmia increases in age patients due to the fact that in old age there are degenerative changes in heart tissue.

The fundamental link in the pathogenesis of atrial fibrillation is the occurrence of multiple re-entry waves.

The Re-entry mechanism is the "return" of an electrical impulse to single muscle fibers. As a result of the continuous circulation of low-amplitude electrical waves, small bundles of atrial muscle tissue contract.

It should be noted that the recirculating wave of excitation is insufficient in strength for the entire myocardium to contract. When the number of re-entry waves reaches a certain critical level, atrial fibrillation occurs.

The time interval of chaotic contractions of individual fibers depends on several factors:

• Values ​​of LP (left atrium).
• The magnitude of the circulating excitation wave.

If the re-entry wavelength is short, and the left atrium is hypertrophied, then the excitatory impulse makes more circles (since the mass of the myocardium is increased). As a consequence, a spontaneous return to sinus rhythm is nearly impossible. In the case of normal heart sizes and with the same return wave length, a smaller number of muscle fibers are involved in the excitation process. In this case, an arrhythmia attack may disappear on its own.

In atrial fibrillation, diastolic filling of the ventricles decreases. This leads to a decrease in cardiac output fraction, which subsequently reduces the oxygen concentration in the peripheral blood. To compensate for the hypoxic state, the ventricular myocardium is gradually remodeled to a hypertrophic type. This increases the mass of the myocardium and the force of contraction of the ventricles.

It is worth noting that compensation occurs up to a certain point, until it exhausts its full potential. Further, the development of subcompensation and decompensation occurs, which is manifested by dilatation of the ventricles and a decrease in cardiac output fraction. Heart failure develops and progresses.

Symptoms of atrial fibrillation

Atrial fibrillation clinic includes:

• A sharp increase in heart rate. The patient perceives as a sudden sensation of palpitations. The heartbeat may go away on its own within a couple of minutes or seconds. However, often this symptom does not disappear within a few days or weeks, which requires the provision of qualified medical care.
• Interruptions in the work of the heart (patients describe this sign of atrial fibrillation as a feeling of "fading" of the heart).
• The appearance of weakness, shortness of breath, pain in chest.
• In the case of heart failure, there are "cardiac" edema. They usually appear in the evening on the legs, after pressing them with a finger, a hole remains. As decompensation increases, the disappearance of edema does not occur.

Diagnosis of atrial fibrillation

To make a diagnosis of atrial fibrillation, the doctor:

• conducts a survey, as a result of which it finds out how long ago the heartbeat, interruptions in the work of the heart began to bother, whether arrhythmia was previously treated;
• conducts an objective study (auscultation of the heart, counts the heart rate, finds out the presence of a pulse deficit);
• prescribes a study - a record of the electrical activity of the heart (ECG). According to the ECG criteria for atrial fibrillation, a conclusion is made about the presence of this heart rhythm disorder.

Atrial fibrillation on EKG

To ECG featured atrial fibrillation include:

• Absence of P wave in front of the ventricular complex (QRS);
• The appearance of waves f;
• different spacing between R-R intervals(that is, the atria and ventricles of the heart contract independently of each other).

Differential Diagnosis

Differential diagnosis of atrial fibrillation is carried out primarily with other arrhythmias, such as:

• sinus tachycardia;
• supraventricular form of paroxysmal tachycardia;
• atrial flutter;
• ventricular paroxysmal tachycardia.

Complaints of the patient with the above forms of arrhythmias will be almost the same. An objective examination will show an increase in heart rate in all cases.

Additional Research

Reliable method differential diagnosis atrial fibrillation from other types of arrhythmias is an electrocardiogram. However, characteristic rhythm changes may not be recorded on the ECG. This may be due to the fact that the patient has periodic form atrial fibrillation (for example, attacks of atrial fibrillation every other day), and the ECG was recorded in the interictal period. In this case, carry out differential diagnosis Holter monitoring can help.

Holter monitoring is instrumental method a study based on a long-term recording of an electrocardiogram. In this case, the patient leads his normal life. At the time of the attack, fibrillation is recorded on the ECG or other types of arrhythmias. A doctor, after analyzing the electrical activity of the heart over a long period, can make a diagnosis of one or another pathology of the heart rhythm.

Also, to establish the cause of atrial fibrillation, it is advisable to conduct additional studies. For example, echocardiography of the heart, which will show the presence of morphological and functional changes in the heart and its valvular apparatus. By general analysis a blood specialist will determine hypoxia, an increased rate of erythrocytes and hemoglobin is responsible for it.

Definition and pathogenesis

ECG with atrial fibrillation (fibrillation).
a - coarse-wavy form;
b - finely wavy form. On the right is a schematic representation of the vortex motion of an excitation wave through the atria.
Mechanisms: the formation of multiple micro-re-entry waves in the atria as a result of complete electrical disorganization of the myocardium and local disturbances in conduction and the duration of the refractory period.

Forms of atrial fibrillation

• coarse-wavy form
• finely wavy form

Causes of atrial fibrillation (atrial fibrillation)

ECG - signs of atrial fibrillation

Classification of atrial fibrillation (atrial fibrillation)

By heart rate:
- normosystolic heart rate 60 - 80 per minute,
- bradysystolic heart rate 60 per minute,
- tachysystolic heart rate > 100 per minute.

Tasks and tactics at the prehospital stage in atrial fibrillation

48 hours is the time during which sinus rhythm can be restored with minimal risk of thromboembolic complications.
Restoring rhythm to more late dates requires 4 weeks of prior anticoagulant therapy with warfarin.

Tasks at permanent form atrial fibrillation:
- heart rate control in the normal range (planned digoxin, beta-blockers),
- prevention of thromboembolic complications (aspirin)

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Atrial flutter is a disturbance of the normal heart rhythm due to the generation of an abnormal impulse outside the sinus node or repeated looping of conduction along a pathological pathway.

As a result, spontaneous but rhythmic contractions of the myocardium occur. The condition is similar to another, fibrillation. However, in the latter case, chaotic movements occur, which are incorrect. This state is much more dangerous. In contrast, flutter is less of a threat to health and life.

At the same time, no one guarantees that without treatment there will be no transition of the process to . Dangerous forms of arrhythmia have serious prognosis in relation to the life of the patient, therefore, the treatment of the underlying condition cannot be delayed.

The assistance scheme has been worked out, there are no problems with elimination at the early stages. If the process has been going on for a long time, organic defects of the heart are observed, which are irreversible in nature. Recovery is almost impossible or very difficult.

Normally, the heart contracts with a certain frequency in two phases. The first is systole. Maximum tension of cardiac structures. The second is diastole. Relaxation, temporary rest of tissues.

The generation of a signal that provides muscle work occurs in the sinus node. This is a small collection of cardiomyocytes. Further along the bundles of His, the signal moves to other similar structures and is conducted to the ventricles.

In the case of atrial flutter, an electrical impulse is generated in the atria. Hence the extra contractions outside the normal rhythm.

The intensity of the signals, however, is low, which ensures the relative correct functioning of the myocardium. This is a temporary phenomenon, with a probability of 60% within 2-3 years, fibrillation will occur, and in the long term - death.

There is another mechanism: abnormal movement of the impulse in the right atrium. It develops due to violations of the conduction system (bundle of His, Bachmann). The signal loops and moves in a circle, provoking re-excitation of muscle tissue.

flutter forms

AT clinical practice There are two types of flutter.

For a typical shape characteristic is the normal movement of the impulse in the myocardium of the right atrium. Usually counterclockwise. Perhaps the reverse development of the state, clockwise.

The direction does not play a big role, although it can confuse a young doctor. The heart rate is limited to 150-300 beats per minute. They are incomplete, because they are almost not felt.

The risks of complications are minimal, but this is temporary. There is a possibility of aggravation of the pathological process.

The atypical form is characterized by the incorrect movement of the electrical impulse. It also affects the left atrium, as well as the isthmus of the venous orifice.

The heart rate is high and is determined by the figure of 300-450 beats per minute. Symptoms are also minimal, such myocardial movements are not felt as full.

Classification by the nature of the flow

A more important clinical classification is the course of the pathological process. Based on this criterion, they call:

• Primary atrial flutter. Occurs spontaneously, previously, as a rule, no episodes were observed, therefore it is impossible to determine the etiology, as well as to predict the further progression of the process. Hospitalization and long-term outpatient observation are required.
• Approach form. The most common. Paroxysm of atrial flutter lasts from 10 minutes to several hours. It is characterized by intense symptoms from the cardiac structures, the general well-being of the patient is disturbed. With a prolonged episode, emergency transesophageal electrical stimulation is performed, which stops the attack.
• persistent type. It is characterized by a violation of the normal heart rhythm on a regular basis. Unlike previous forms, the duration of episodes can be several days. Such protracted paroxysms require emergency assistance there is a risk of cardiac arrest.
• permanent form. Stabilization of the state in the pathological channel requires a number of years of development. In other cases, everything happens faster. Recovery is carried out in a hospital. Conservative methods do not always work, more often radical help is required.

A big role is given not to the duration of the attack, but to the severity with which it proceeds. The main assessment factors are the frequency of contractions, the general well-being of the patient, the presence of concomitant manifestations from the heart structures, the nervous system.

Causes of the primary form of AFL

Factors in the development of the pathological process are not always cardiac. Depending on the main moment that provokes the onset of arrhythmia, primary and secondary (extracardiac) forms are distinguished.

• . Congenital heart disease. It is characterized by the formation of an excess conductive bundle (Kent's bundle), which provides excessive excitation of cardiac structures.

Accompanied by severe symptoms. Atrial flutter is one possible option, but not the most common. According to statistics, the frequency of this form is 0.3-0.5%, fibrillation, which is also likely, is determined in almost 4% of cases.

• Infectious-inflammatory or autoimmune lesions of the heart muscle, pericardium. The symptoms are also pronounced, which will not allow you to ignore the condition. Treatment is carried out in a hospital with the use of antibiotics, corticosteroids, as needed - immunosuppressants in minimal dosages.

The acute process entails the destruction of the atria in the short term. Recovery in such a situation is surgical without guarantees of success. The same consequence of a long-term chronic process with frequent relapses.

• . Violation of the development of the heart muscle. There are several forms. All of them are similar in one thing: the normal muscle tone decreases, its volume grows or contracts, depending on the type of process. It is possible to expand the chambers of the cardiac structures. Treatment only makes sense early stages. Then - a symptomatic effect, it fights with a consequence, and not with a cause.

• Heart defects congenital and acquired. The most common violations of functional activity, and the anatomical development of valves (aortic, mitral). Correction is strictly surgical, in a short time. According to indications. Going under the knife without good reason is not a good idea.

• Heart attack, and subsequent cardiosclerosis. From point of view dangerous complications, the threat is not so much the acute death of heart cells itself, but the subsequent scarring of the affected areas.

There are areas of rough connective tissue. They do not contract, do not have elasticity, do not conduct a signal.

Hence the violation of the normal functional activity of cardiac structures. The same effect is provoked by myocarditis, other inflammatory pathologies, ischemic disease, .

Causes of the secondary form of AFL

Extracardiac factors also occur, their share in the total mass of causes is up to 40%. These are secondary forms of atrial flutter:

• . Not of cardiac origin. The occurrence of spontaneous myocardial contractions of uncertain etiology. Over time, it provokes tertiary changes in rhythm.
• Hyperthyroidism. Excess synthesis of thyroid hormones. It intensifies the work of all body systems. including cardiovascular. Recovery is carried out under the supervision of an endocrinologist. Therapy lasts from 3 months to a year or more. It is also necessary to influence the root cause of the condition.
• Diabetes.
• Respiratory failure in the subcompensation phase or a completely uncontrolled process. accompanied by hypoxia. Diagnoses are variable: asthma, COPD, emphysema, other conditions.
• metabolic problems. They are characterized by a deviation in the exchange of potassium, magnesium, sodium (to a lesser extent).

Risk factors

An important role is played by factors that cannot strictly be classified as pathological, but increase the degree of danger:

• Prolonged smoking. Long-term tobacco users are at greater risk. In this case, not only the duration, but also the body's own resistance is important. It is assumed that it is genetically determined.
• old age. From 60 years and more.
• Belonging to the male sex. According to various estimates, the likelihood of atrial flutter is 6-8 times higher than in women.

trigger factors

The onset of an attack can be spontaneous or provoked by triggers:

• Consumption of coffee, tea, alcoholic beverage (does not depend on quantity).
• Smoking.
• Intense stress.
• Physical overload.
• High air temperature, humidity, adverse climatic conditions. Especially during the summer months. Hearts are encouraged to go outside as little as possible.
• Excess liquid the day before. Especially against the background of renal pathologies of a dysfunctional nature, when the evacuation of urine is disturbed.
• Addiction to drugs, psychoactive drugs, the use of drugs of the glucocorticoid group and others.

Symptoms

The clinical picture is nonspecific. According to the manifestations, it is impossible to say about the nature of the process, its origin. However, attacks clearly let you know about health problems and motivate you to see a doctor.

Sample symptoms:

• Violation of the heart rhythm. It is subjectively felt as a sharp blow, irregular, too frequent beating, missing contractions. Against the background of the course of mixed processes, the intensity of symptoms may increase.
• Pain in the chest. Burning or pressing. Not high strength. With the development of acute coronary insufficiency, the feeling is more pronounced. Cupping is carried out with analgesics.
• Tachycardia. Acceleration of cardiac activity. Heart rate reaches 110-120 beats and more.
• Dyspnea. Sudden, excludes any physical activity. Outside the attack, the manifestation is absent until some time. Gradually acquires a persistent character and accompanies the patient constantly.
• The fall blood pressure. Insignificant. 90/70 or so.
• Headache, vertigo, disorientation in space.
• Weakness, drowsiness, decreased activity.

In some cases, symptoms are completely absent. The intensity of manifestations is determined by the involvement of the ventricles in the process. If they are not affected, usually the symptoms are minimal.

First aid for paroxysm

It is carried out at home or in a hospital. At the same time, independently prehospital stage, an attack can be removed only in the early stages, when there are no organic defects. With concomitant pathologies, the chances of stopping are minimal.

Anyway, the algorithm is:

• Call an ambulance.
• Measure blood pressure. Heart rate.
• Open a vent or window to ensure adequate ventilation of the room.
• Take prescribed medications. If there has not yet been a consultation with a cardiologist, Anaprilin (half a tablet) can be used. But this is an extreme case. Nothing more can be taken in order to avoid complications.
• Take a semi-recumbent position, put a roller from improvised materials under your back.
• Breathe rhythmically (5 seconds for each movement).
• Calm down. In the event of an acute panic attack, take a herbal sedative: motherwort or valerian tablets. Just not alcohol.
• Wait for the arrival of specialists, do not make sudden movements and generally move less.

Upon arrival of the brigade, report on the condition. Hospitalization is possible, it is not recommended to refuse it.

Important to keep in mind:

First aid - pre-medical. It is not aimed at a total cure. Her task is to stabilize the condition before the arrival of doctors, in order to avoid complications.

Diagnostics

Carried out by a cardiologist. With a controversial origin of the process, the involvement of third-party specialists is shown: neurologists and others.

Scheme of events:

• Oral questioning of the patient for complaints, collection of anamnesis. Both methods play a huge role, because they allow you to navigate the situation.
• Measurement of blood pressure, heart rate.
• Auscultation. Listening to the sound created during contractions and relaxation of the cardiac structures.

Routine methods do not provide exhaustive information. They are necessary to determine the vector of further diagnostics.

• Electrocardiography. Identification of functional deviations. The main method of examination of patients with atrial flutter.
• Echocardiography. It is aimed at determining complications, organic defects.
• Daily monitoring. Measurement of blood pressure and heart rate for 24 hours in dynamics, taking into account circadian rhythms, patient activity.

As part of advanced diagnostics: blood tests, urine tests, assessment neurological status, electroencephalography, MRI, thyroid scintigraphy, sugar curve.

Signs on the ECG

Typical features of flutter on the cardiogram:

• Normal ventricular complexes (unless these chambers are affected).
• Absence of P waves.
• The presence of peaks F.
• Acceleration of heart rate up to 200-450 beats per minute.
• QRS< 0.12 сек.
• Short PR interval.

A characteristic model of the pathological process is noticeable, including to an inexperienced doctor. Gross changes occur even in the early stages. Atrial flutter on the ECG is supplemented by 24-hour Holter monitoring data.

Treatment Methods

The therapy is carried out in three stages:

• Relief of an acute condition.
• Eliminate the root cause.
• symptomatic effect.

The last two are carried out in parallel.

Solving the problem of removing the patient from paroxysm:

• The use of medicines. Beta-blockers (Aprilin, Carvedilol have high therapeutic activity, others like Metoprolol are also effective, but give more side effects), calcium channel blockers (Diltiazem as the main one). Also antiarrhythmic (Amiodarone or Quindine) in strictly adjusted dosages.
• In case of inefficiency - electrocardioversion. Elimination of paroxysm by external conduction of current. Efficiency varies.

• Transesophageal pacing (TEPS) is also possible. The essence remains the same. The technique has a greater effect due to invasiveness.

Against the background of the lack of action, a radical surgical technique is shown. The main one is radiofrequency ablation - cauterization of a focus that generates an abnormal signal or elimination of a path that conducts an impulse in a circle.

Medical treatment of atrial flutter is the primary measure, surgery is resorted to in extreme cases due to the presence of risks.

Life prognosis and possible complications

The outcome is favorable in 80% of situations. The survival rate in the early stages is almost 100%. Much depends on the underlying diagnosis (root cause).

Only a doctor can say anything concrete after a certain period of dynamic observation (about 1-3 months).

Likely consequences:

• Atrial or ventricular fibrillation.
• Stopping the work of a muscular organ.
• Thromboembolism.
• Heart attack.
• Stroke.
• Death eventually.

Atrial flutter is one of the types of supraventricular tachycardia, when the atria contract too quickly, but these are not full-fledged contractions, but small twitches of muscle fibers, so the heart rhythm remains comfortable.

Treatment under the supervision of a cardiologist. Forecasts are favorable in most cases, except for severe heart defects. Even then, the chances of a complete cure are present.

Atrial flutter (AF) is one of the supraventricular tachycardias, when the atria contract at a very high speed - more than 200 times per minute, but the rhythm of contractions of the whole heart remains correct.

Atrial flutter is several times more common in men, among patients - usually older people aged 60 years and older. The exact prevalence of this type of arrhythmia is difficult to establish due to its instability. AFL is often short-term, so it can be difficult to fix it on the ECG and in the diagnosis.

Atrial flutter lasts from a few seconds to several days (paroxysmal form), rarely - more than a week. In the case of a short-term disturbance of the rhythm, the patient feels discomfort, which quickly passes or replaces it. In some patients, flutter with flickering are combined, periodically replacing each other.

The severity of symptoms depends on the rate of atrial contraction: the greater it is, the higher the likelihood of hemodynamic disorders. This arrhythmia is especially dangerous in patients with severe structural changes in the left ventricle, in the presence of chronic heart failure.

In most cases, with atrial flutter, the rhythm is restored by itself, but it happens that the disorder progresses, the heart cannot cope with its function, and the patient needs urgent health care. Antiarrhythmic drugs do not always give the desired effect, therefore TP is the case when it is advisable to resolve the issue of cardiac surgery.

Atrial flutter is a serious pathology, although not only many patients, but also doctors do not pay due attention to its episodes. The result is an expansion of the chambers of the heart with progressive insufficiency, thromboembolism, which can cost lives, therefore, any attack of rhythm disturbance should not be ignored, and when it appears, it is worth heading to a cardiologist.

How and why does atrial flutter appear?

Atrial flutter is a variant of supraventricular tachycardia, that is, a focus of excitation appears in the atria, causing them to contract too frequently.

The rhythm of the heart during atrial flutter remains regular, in contrast to (atrial fibrillation), when the atria contract rapidly and chaotically. More rare contractions of the ventricles are achieved by a partial blockade of the conduction of impulses to the ventricular myocardium.

The causes of atrial flutter are quite diverse, but always based on organic damage to the heart tissue, that is, a change in the anatomical structure of the organ itself. This can be associated with a higher incidence of pathology in the elderly, while in young arrhythmias are more functional and dysmetabolic in nature.

Among the diseases accompanied by TP, one can note:

• Ischemic disease in the form of a diffuse, post-infarction scar or;
• Inflammatory processes in and;
• , especially with a strong .

There are frequent cases of atrial flutter in patients with pulmonary pathology - chronic obstructive diseases (bronchitis, asthma, emphysema),. Predisposes to this phenomenon the expansion of the right heart due to increased pressure in pulmonary artery against the background of sclerosis of the parenchyma and vessels of the lungs.

After cardiac surgery in the first week, the risk of this type of rhythm disturbance is high. It is diagnosed after correction of congenital defects, coronary artery bypass grafting.

risk factors for atrial fibrillation consider diabetes mellitus, electrolyte disturbances, excess hormonal function of the thyroid gland, various intoxications (drugs, alcohol).

As a rule, the cause of atrial flutter is clear, but it happens that arrhythmia overtakes a practically healthy person, then we are talking about the idiopathic form of AF. The role of the hereditary factor cannot be excluded.

At the heart of the mechanism of atrial flutter is the repeated excitation of the atrial fibers of the macro-re-entry type (the impulse, as it were, goes in a circle, involving in the contraction those fibers that have already contracted and should be relaxed at this moment). “Re-entry” of the impulse and excitation of cardiomyocytes is characteristic of structural damage (scar, necrosis, inflammatory focus), when an obstacle is created for the normal propagation of the impulse along the fibers of the heart.

Arising in the atrium and causing repeated contraction of its fibers, the impulse nevertheless reaches the atrioventricular (AV) node, but since the latter cannot conduct such frequent impulses, then there is - at most - half of the atrial impulses reaching the ventricles.

The rhythm remains regular, and the ratio of the number of atrial and ventricular contractions is proportional depending on the number of impulses conducted to the ventricular myocardium (2:1, 3:1, etc.). If half of the impulses reach the ventricles, then the patient will have a tachycardia of up to 150 beats per minute.

atrial flutter going from 5:1 to 4:1

It is very dangerous when all atrial impulses reach the ventricles, and the ratio of systoles of all parts of the heart becomes 1:1. In this case, the rhythm frequency reaches 250-300, hemodynamics is sharply disturbed, the patient loses consciousness and signs of acute heart failure appear.

Atrial fibrillation can spontaneously turn into atrial fibrillation, which is not characterized by a regular rhythm and a clear ratio of the number of ventricular to atrial contractions.

In cardiology, there are two types of atrial flutter:

typical and reverse typical TP

1. typical;
2. Atypical.

With a typical variant syndrome TP wave of excitation goes through the right atrium, the frequency of systoles reaches 340 per minute. In 90% of cases, the contraction occurs around the tricuspid valve counterclockwise, in the remaining patients - clockwise.

At atypical form TP the myocardial excitation wave does not pass in a typical circle, affecting the isthmus between the mouth of the vena cava and the tricuspid valve, but along the right or left atrium, causing contractions up to 340-440 per minute. This form cannot be stopped by transesophageal pacing.

Manifestations of atrial flutter

In the clinic it is customary to allocate:

• For the first time atrial flutter;
• paroxysmal form;
• Permanent;
• Persistent.

At paroxysmal form, the duration of TP is not more than a week, the arrhythmia disappears spontaneously. Persistent the course is characterized by a violation duration of more than 7 days, and self-normalization of the rhythm is impossible. O constant form it is said when an attack of flutter cannot be stopped or treatment has not been carried out.

It is not the duration of TP that is of clinical importance, but the frequency with which the atria contract: the higher it is, the more pronounced the hemodynamic disturbance and the more likely the complications. With frequent contractions, the atria do not have time to provide the ventricles with the necessary volume of blood, gradually expanding. With frequent episodes of atrial flutter or a constant form of pathology, circulatory disorders in both circles occur, and dilated cardiomyopathy is possible.

In addition to insufficient cardiac output, importance also has a lack of blood flowing to coronary arteries. With severe AFL, the lack of perfusion reaches 60% or more, and this is the likelihood of acute heart failure and infarction.

Clinical signs of atrial flutter appear with paroxysmal arrhythmias. Among the complaints of patients, weakness, fatigue are possible, especially when exercise, discomfort in the chest, rapid breathing.

With a deficiency of coronary circulation, symptoms appear, in patients with coronary heart disease, pain intensifies or is progressive. The lack of systemic blood flow contributes to hypotension, then dizziness, darkening of the eyes, and nausea are added to the symptoms. A high atrial rate can cause syncope and severe fainting.

Attacks of atrial flutter often appear in hot weather, after physical effort, strong emotional experiences. Alcohol intake and errors in diet, intestinal disorders can also provoke paroxysms of atrial flutter.

When there are 2-4 atrial contractions per ventricular contraction, patients show relatively few complaints, this ratio of contractions is easier to tolerate than atrial fibrillation, because the rhythm is regular.

The danger of atrial flutter lies in its unpredictability: at any moment, the frequency of contractions can become very high, a heartbeat will appear, shortness of breath will increase, symptoms of insufficient blood supply to the brain will develop - dizziness and fainting.

If the ratio of atrial to ventricular contractions is stable, then the pulse will be rhythmic, but when this ratio fluctuates, the pulse will become irregular. characteristic symptom there will also be a pulsation of the veins of the neck, the frequency of which exceeds the pulse on the peripheral vessels by two or more times.

As a rule, atrial fibrillation appears in the form of short and infrequent paroxysms, but with a strong increase in contractions of the heart chambers, complications are possible - thromboembolism, pulmonary edema, acute heart failure, ventricular fibrillation and death.

Diagnosis and treatment of atrial flutter

In the diagnosis of atrial flutter, electrocardiography is of paramount importance. After examining the patient and determining the pulse, the diagnosis can only be conjectural. When the ratio between the contractions of the heart is stable, then the pulse will be either more frequent or normal. With fluctuations in the conduction coefficient, the rhythm will become irregular, as with atrial fibrillation, but it is impossible to distinguish between these two types of disturbance by pulse. In the primary diagnosis, the assessment of the pulsation of the veins of the neck, which exceeds the pulse by 2 or more times, helps.

ECG signs of atrial flutter consist of the appearance of so-called atrial F waves, but the ventricular complexes will be regular and unchanged. With daily monitoring, the frequency and duration of paroxysms of atrial fibrillation, their relationship with stress, sleep are recorded.

Video: ECG lesson for non-sinus tachycardia

To clarify the anatomical changes in the heart, diagnose the defect and determine the location of organic damage, during which the doctor specifies the size of the cavities of the organ, the contractility of the heart muscle, and the features of the valvular apparatus.

As additional methods laboratory diagnostics are used - determination of the level of thyroid hormones in order to exclude thyrotoxicosis, rheumatic tests for rheumatism or suspicion of it, determination of blood electrolytes.

Treatment of atrial flutter can be medical and cardiac surgery. Of great difficulty is the resistance of TP to drug exposure, in contrast to flicker, which almost always can be corrected with drugs.

Medical therapy and first aid

Conservative treatment includes the appointment:

• (metoprolol);
• (verapamil, diltiazem);
• Antiarrhythmic drugs (amiodarone, flecainide, ibutilide);
• Potassium preparations;
• (digoxin);
• (warfarin, heparin).

Beta-blockers, cardiac glycosides, calcium channel blockers are prescribed in parallel with antiarrhythmics in order to prevent improvement in conduction in the atrioventricular node, since there is a risk that all atrial impulses will reach the ventricles and provoke ventricular tachycardia. Verapamil is most commonly used to control ventricular rate.

If paroxysm of atrial flutter occurs against a background when conduction along the main pathways of the heart is disturbed, all drugs from the above groups are strictly contraindicated, except for anticoagulants and antiarrhythmic drugs.

Emergency care for paroxysmal atrial flutter, accompanied by angina pectoris, signs of cerebral ischemia, severe hypotension, progression of heart failure consists in emergency electrical cardioversion with low power current. In parallel, antiarrhythmics are administered, which increase the effectiveness of electrical stimulation of the myocardium.

Drug therapy for an attack of flutter is prescribed at the risk of complications or poor tolerance of an attack, while amiodarone is injected into a vein in a jet. If amiodarone does not restore the rhythm within half an hour, cardiac glycosides (strophanthin, digoxin) are indicated. In the absence of the effect of drugs, electrical pacing is started.

Another treatment regimen is possible with an attack, the duration of which does not exceed two days. In this case, procainamide, propafenone, quinidine with verapamil, disopyramide, amiodarone, and electrical impulse therapy are used.

If appropriate, transesophageal or intraatrial myocardial stimulation is indicated to restore sinus rhythm. The impact of ultra-high frequency current is carried out by patients who have undergone heart surgery.

If atrial flutter lasts more than two days, then before proceeding, anticoagulants (heparin) must be administered to prevent thromboembolic complications. Within three weeks of anticoagulant therapy, beta-blockers, cardiac glycosides, and antiarrhythmic drugs are prescribed in parallel.

Surgical treatment

RF ablation in LT

With a constant variant of atrial flutter or frequent relapses a cardiologist may recommend conducting, effective in the classical form of TP with circular circulation of the impulse through the right atrium. If atrial flutter is combined with the syndrome of weakness of the sinus node, then in addition to ablation of the conduction pathways in the atrium, the atrioventricular node is also subjected to current, and subsequently, providing the correct heart rhythm.

Stability of atrial flutter to drug treatment leads to more and more frequent use radiofrequency ablation (RFA), which is especially effective in a typical form of pathology. The action of radio waves is directed to the isthmus between the mouth of the vena cava and the tricuspid valve, where the electrical impulse circulates most often.

RFA can be performed both at the time of paroxysm and planned in sinus rhythm. The indication for the procedure will be not only a protracted attack or severe course of atrial fibrillation, but also the situation when the patient agrees to it, since the long-term use of conservative methods can provoke new types of arrhythmias and is not economically feasible.

Absolute indications for RFA- lack of effect from antiarrhythmic drugs, their unsatisfactory tolerance or the patient's unwillingness to take any medication for a long time.

A distinctive feature of TP is its resistance to drug treatment and a greater likelihood of recurrence of an attack of flutter. This course of the pathology is very predisposing to intracardiac thrombosis and the spread of blood clots along big circle, as a result - strokes, intestinal gangrene, heart attacks of the kidneys and heart.

The prognosis for atrial flutter is always serious, but depends on the frequency of arrhythmia paroxysms and duration, as well as on the rate of atrial contraction. Even with a relatively favorable course of the disease, one cannot ignore it or refuse the proposed treatment, because no one can predict how strong and how long the attack will be, and, therefore, the risk of dangerous complications and death of the patient from acute insufficiency There are always hearts in TP.

Video: atrial flutter, the program “Live great!”