Background: Little is known about the prevalence of Atrial thrombosis in Atrial flutter undergoing cardioversion of rhythm. Several studies, however, have shown that patients with Atrial fibrillation have a high prevalence of Atrial thrombosis, strongly associated with increased risk of embolism in Atrial fibrillation. Still, the incidence of Atrial thrombi in patients with Atrial flutter is not well established.Methods: Transesophageal echocardiography was done in 30 consecutive non-anticoagulated patients with a mean age of 48.4 years who were admitted for cardioversion of Atrial flutter. Mean left Atrial size was 4.3cm and mean ejection fraction was 42%. The mean duration of flutter was more than 48 hours. Left Atrial thrombus was seen in 2 patients.Results: Two patients had left Atrial thrombosis and both of them had rheumatic mitral stenosis. The other patients were free of thrombosis.Conclusion: This study suggests that Atrial thrombus is uncommon in patients with Atrial flutter, and there is a low risk of thromboembolism after cardioversion, except in rheumatic mitral stenosis, which itself has a high prevalence of left Atrial thrombosis.

The mechanism of typical Atrial flutter (AFL) has been well established. The isthmus between the tricuspid annulus and Eustachian ridge has been recognized as a critical part for maintaining the typical AFL circuit and the target site for ablation. However, a subtype of AFL, as double-wave reentry [lower loop reentry], has been described. This arrhythmia is due to the presence of 2 activation wavefronts rotating simultaneously. In this case report, we presented a case of counter-clockwise AFL with such activation circuit.

Background: Atrial flutter (AFL) and Atrial Fibrillation (AF) are among the most common supraventricular tachyarrhythmias. Sometimes, differentiation of the two arrhythmias using surface electrocardiography becomes difficult. Objectives: This study aimed to compare the Left Atrial Appendage (LAA) ejection flow waves of AFL and AF to determine whether it can serve as a method for differentiating the two arrhythmias. Methods: This cross-sectional study was conducted on 20 patients with AF and 20 ones with AFL selected via simple sampling method. During Trans-Esophageal Echocardiography (TEE), pulsed Doppler sampling was laid 1 cm inside the LAA and pattern of LAA ejection flow waves was recorded in terms of rate (number per minute), velocity (centimeter per second), and regularity. The two groups were compared using Mann-Whitney U-test. P ≤ 0. 05 was considered to be statistically significant. Results: The rate of LAA ejection flow waves was 493. 75 ± 50. 57 in the AF group and 303. 50 ± 16. 31 in the AFL group (P < 0. 001). Besides, the mean velocity was 0. 172 ± 0. 069 m/s in the AF group and 0. 302 ± 0. 106 m/s in the AFL group (P < 0. 001). Velocity more than 0. 17 m/s had a sensitivity of 95. 0% (95% CI, 75. 1-99. 2%), specificity of 70. 0% (95% CI, 45. 7-88. 0%), positive predictive value of 76. 0%, and negative predictive value of 93. 03% for diagnosing AFL. All patients in the AF group had irregular patterns, but all those in the AFL group had regular patterns. Conclusion: Since TEE is a usual part for evaluation of patients suspected to have AF or AFL, it may be helpful for differentiating AFL from AF by examining LAA ejection flow waves.

It has been well-established that common Atrial flutter is due to intra-Atrial macroreentry and its reentry circuit locates in the right atrium. This reentry circuit has been characterized to involve an area of slow conduction identifiable electrophysiologically at the low post-eroseptal right atrium and anatomical narrow isthmus surrounded by the inferior vena cava, coronary sinus ostium and tricuspid valve annulus. We performed radiofrequency catheter ablation for common Atrial flutter using anatomical approach in one patient. In this report, we discuss the efficacy of catheter ablative therapy and its results in our patient

Background: Neonatal Cardiac Arrhythmias are found in 1% to 5% of newborns during the first 10 days of life. The most common symptomatic arrhythmia in the neonatal period is Supra Ventricular Tachicardia(SVT), which has an incidence of 1/25, 000. Idiopathic neonatal Atrial flutter (AFL) is a rare rhythm disorder usually occurring in the first days of life and characterized by sustained tachycardia in newborns and infants with an Atrial rate around 340-580 beats/minute(BMP). AFL may manifest as asymptomatic tachycardia, congestive heart failure, or hydrops and may be life-threatening and fatal. Case presentation: We reported a 38 weeks female neanate presented with tachycardia during the first physical examination and recieved adenosine therapy and cardioversion. Conclusion: AFL, as a rare but life-threatening rhythm disorder in the fetal and neonatal period that can cause fetal hydrops and infant death, should be considered by neonatologists.

A 42-years-old woman presented with palpitation. Her symptoms aggravated since 2 years ago, and developed palpitation and syncope during its last six months. Her symptoms continued despite the medical therapy. During heart monitoring in CCU, she developed a narrow QRS complex tachycardia with rate of 150 beats/min. After injection of adenosine, ventricular rate slowed down and the flutter waves were appeared. In electrophysiology study (EPS), reverse Atrial flutter was induced. Bidirectional cavotricuspid isthmus block by application of radiofrequency energy was done for her. No arrhythmia was induced after radiofrequency ablation. The patient was discharged and during follow up is free of symptoms.

Background: Arrhythmias in neonates are not common and usually affect newborns with a normal heart or those that suffer from structural heart disease. A malignant type of arrhythmias is supraventricular tachycardia. Meanwhile, one uncommon type of supraventricular arrhythmias is Atrial flutter (AFL), which is founded upon reentry mechanisms in the atrium. The AFL may result in heart failure or even death, but the majority of its cases have revealed favorable prognosis in the event of early prenatal diagnosis and immediate treatment. Case report: A four-day term male newborn with a birth weight of 4, 560 g born to a 43-year-old multiparous mother was delivered through cesarean section. The patient’ s admission to the hospital was on account of her poor feeding and tachypnea. The results of physical checkup exhibited tachycardia with 210 beats/min, and electrocardiogram (ECG) indicated a narrow QRS complex tachycardia with P-waves in the leads II and III that showed AFL. The adenosine injection revealed atrioventricular conduction 2. 1. Therefore, oral propranolol therapy with a dosage of 3 mg/kg/day was prescribed for the patient. Given the recurrence of AFL, cardioversion was conducted with 0. 25 joule/kg until the rhythm was restored to normal. Later, the normal sinus rhythm was observed on ECG. Fifteen days after birth, the patient was discharged with a perfect general state. The results of a 6-month follow-up did not show any AFL. Conclusion: Despite its rare occurrence, AFL must be considered in the differential diagnosis of newborns with poor feeding with tachypnea and tachycardia.