In patients without a history of heart disease, cardiac surgery or catheter ablation, typical flutter ECG remains predictive of a right atrial re-entry circuit dependent on the inferior vena cava–tricuspid isthmus that can be very effectively treated by ablation, although late incidence of atrial fibrillation remains a problem. Electrophysiological studies have defined multiple mechanisms of tachycardia, both re-entrant and focal, with varying ECG morphologies and rates, authenticated by the results of catheter ablation of the focal triggers or critical isthmuses of re-entry circuits.
85-98.Clinical electrophysiology has made the traditional classification of rapid atrial rhythms into flutter and tachycardia of little clinical use.
Pediatric and Congenital Electrophysiology: From Fetus to Adult. In: Saul JP, Triedman JK, Walsh EP, editors. Moss and Adams’ Heart Disease in Infants, Children, and Adolescents: Including the Fetus and Young Adult. In: Allen HD, Shaddy RE, Penny DJ, Cetta F, Feltes TF, editors. Pediatric Arrhythmias: Electrophysiology and Pacing. In: Crawford MH, DiMarco JP, Paulus WJ, editors. Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care. In: Walsh EP, Saul JP, Triedman JK, editors. Education and Support: Providing education and support to pediatric patients and their families regarding atrial flutter, its management, and the importance of medication adherence can empower them to actively participate in their care and make informed decisions.Lifestyle Modifications: Encouraging a healthy lifestyle that includes regular physical activity, a balanced diet, and adequate hydration can promote overall cardiovascular health and potentially reduce the risk of arrhythmias.Treating and managing these underlying conditions can help reduce the frequency and severity of atrial flutter episodes. Prevention and Long-Term Management: Identifying and addressing underlying risk factors, such as structural heart defects or electrolyte imbalances, is crucial for long-term management of atrial flutter in pediatric patients.Catheter Ablation: In certain cases, pediatric patients with recurrent or drug-resistant atrial flutter may benefit from catheter ablation, a minimally invasive procedure that selectively targets and eliminates the abnormal electrical pathways in the heart.Pharmacological Therapy: Antiarrhythmic medications, such as intravenous or oral flecainide, amiodarone, or propafenone, may be employed for acute rate control and long-term maintenance of sinus rhythm.Acute Conversion of Atrial Flutter: In unstable patients or those experiencing severe symptoms, immediate electrical cardioversion may be necessary to restore sinus rhythm and improve hemodynamic stability.The specific approach depends on the patient’s clinical condition, symptoms, underlying causes, and associated risk factors. The management of atrial flutter in pediatric patients involves both acute intervention and long-term strategies. Management Approaches for Atrial Flutter in Pediatric Patients:
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