Pediatric Atrial Flutter Differential Diagnoses

  • Author: M Silvana Horenstein, MD; more...
 
Updated: Jan 27, 2012
 
 

Diagnostic Considerations

Atrial flutter must be differentiated from atrial fibrillation and chaotic atrial tachycardia. When atrial flutter is conducted to the ventricle in a 1:1 fashion, the electrocardiogram may resemble ventricular tachycardia. In patients with a 2:1 conduction ratio, the ECG findings often suggest a mild sinus tachycardia with first-degree AV block.

Go to Atrial Flutter and Emergent Management of Atrial Flutter for complete information on these topics.

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

M Silvana Horenstein, MD  Assistant Professor, Department of Pediatrics, University of Texas Medical School at Houston; Medical Doctor Consultant, Legacy Department, Best Doctors, Inc

M Silvana Horenstein, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Robert Murray Hamilton, MD, MSc, FRCPC  Section Head, Electrophysiology, Senior Associate Scientist, Physiology and Experimental Medicine, Labatt Family Heart Centre; Professor, Department of Pediatrics, University of Toronto Faculty of Medicine

Robert Murray Hamilton, MD, MSc, FRCPC is a member of the following medical societies: American Heart Association, Canadian Cardiovascular Society, Canadian Medical Association, Canadian Medical Protective Association, Cardiac Electrophysiology Society, Heart Rhythm Society, Ontario Medical Association, Pediatric Electrophysiology Society, Royal College of Physicians and Surgeons of Canada, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Alvin J Chin, MD Professor of Pediatrics, University of Pennsylvania School of Medicine; Attending Physician, Cardiology Division, Children's Hospital of Philadelphia

Alvin J Chin, MD, is a member of the following medical societies: American Association for the Advancement of Science, American Heart Association, and Society for Developmental Biology

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References

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  2. Boriani G, Gallina M, Merlini L, et al. Clinical relevance of atrial fibrillation/flutter, stroke, pacemaker implant, and heart failure in Emery-Dreifuss muscular dystrophy: a long-term longitudinal study. Stroke. Apr 2003;34(4):901-8. [Medline].

  3. Nazarian S, Wagner KR, Caffo BS, Tomaselli GF. Clinical predictors of conduction disease progression in type I myotonic muscular dystrophy. Pacing Clin Electrophysiol. Feb 2011;34(2):171-6. [Medline]. [Full Text].

  4. Frost L, Hune LJ, Vestergaard P. Overweight, obesity and risk factors for atrial fibrillation or flutter--secondary publication.The cohort study Diet, Cancer and Health. Ugeskr Laeger. Sep 12 2005;167(37):3507-9. [Medline].

  5. Frost L, Vestergaard P. Alcohol consumption and the risk of atrial fibrillation or flutter--secondary publication. A cohort study. Ugeskr Laeger. Aug 29 2005;167(35):3308-10. [Medline].

  6. Frost L, Vestergaard P, Mosekilde L. Hyperthyroidism and risk of atrial fibrillation or flutter--secondary publication. A population-based study. Ugeskr Laeger. Aug 29 2005;167(35):3305-7. [Medline].

  7. Movahed MR, Hashemzadeh M, Jamal MM. Diabetes mellitus is a strong, independent risk for atrial fibrillation and flutter in addition to other cardiovascular disease. Int J Cardiol. Dec 7 2005;105(3):315-8. [Medline].

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  12. Liberman L, Pass RH, Starc TJ. Optimal surface electrocardiogram lead for identification of the mechanism of supraventricular tachycardia in children. Pediatr Emerg Care. Jan 2008;24(1):28-30. [Medline].

  13. Liberman L, Hordof AJ, Altmann K, Pass RH. Low energy biphasic waveform cardioversion of atrial arrhythmias in pediatric patients and young adults. Pacing Clin Electrophysiol. Dec 2006;29(12):1383-6. [Medline].

  14. Stulak JM, Dearani JA, Puga FJ. Right-sided Maze procedure for atrial tachyarrhythmias in congenital heart disease. Ann Thorac Surg. May 2006;81(5):1780-4; discussion 1784-5. [Medline].

  15. Naccarelli GV, Wolbrette DL, Levin V, et al. Safety and efficacy of dronedarone in the treatment of atrial fibrillation/flutter. Clin Med Insights Cardiol. 2011;5:103-19. [Medline]. [Full Text].

  16. Oudijk MA, Ruskamp JM, Ververs FF, et al. Treatment of fetal tachycardia with sotalol: transplacental pharmacokinetics and pharmacodynamics. J Am Coll Cardiol. Aug 20 2003;42(4):765-70. [Medline].

  17. Rebelo M, Macedo AJ, Nogueira G, Trigo C, Kaku S. Sotalol in the treatment of fetal tachyarrhythmia. Rev Port Cardiol. May 2006;25(5):477-81. [Medline].

 
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Rhythm strip depicting lead II of a patient with atrial flutter with an atrial rate of 300 beats per minute (bpm). Atrioventricular conduction rate is variable at 2:1 and 3:1. Therefore, the ventricular rate ranges from 100-150 bpm.
 
 
 
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