Epidemiology
The overall incidence has been reported as 88/100,000 person-years, with increasing rates with older age. The incidence is 5/100,000 in people <50 years of age and 587/100,000 in those >80 years of age.[6] It occurs 2.5 times more frequently in men than in women, and increases exponentially with age.[5] Atrial fibrillation often co-exists with atrial flutter, occurring in 24% to 62% of individuals before flutter ablation and in 30% to 70% after flutter ablation.[5] Most cases (>98%) are associated with an identifiable predisposing event or a pre-existing comorbidity.[6]
Risk factors
Mitral or tricuspid valve stenosis or regurgitation can lead to atrial dilation. Dilation promotes the development and maintenance of re-entrant circuits.
Can lead to atrial dilation. Dilation promotes the development and maintenance of re-entrant circuits.
Some pathological conditions (e.g., MI or pulmonary embolism) can lead to atrial dilation; or, rarely, this occurs in the absence of structural heart disease. Dilation promotes the development and maintenance of re-entrant circuits.
Although atrial fibrillation is the most common post-cardiac surgery arrhythmia, atrial flutter can occur and is due to pericarditis, alterations in autonomic tone, or atrial ischaemia.[2][12]
Transient atrial flutter in the first 2 months after pulmonary vein isolation procedures is common and may not necessitate long-term treatment. Can occur in up to 55% of such patients.[13]
Any surgical incision involving the atria can result in atrial flutter with the flutter circuit involving atypical isthmuses between anatomical barriers, prior atrial incision sites, and scarred regions, as well as the cavotricuspid isthmus.[2][11][13][14][15][16][17]
Scarring from prior atrial ablation lesions can lead to development of a re-entrant circuit.[13]
Approximately 10% to 30% incidence at 5- to 10-year follow-up after congenital heart disease operative corrections.[18] May also be associated with procedures such as valve surgery, in which atrial incisions or maze procedures were performed.
The risk of developing atrial flutter is increased 3.5 times in the presence of heart failure. In 16% of patients with atrial flutter, the arrhythmia was attributable to heart failure in a population-based epidemiological study.[6]
May precipitate atrial fibrillation or atrial flutter.
In 12% of patients with atrial flutter, the arrhythmia was attributable to COPD in a population-based epidemiological study.[6] May precipitate atrial fibrillation or atrial flutter.
May precipitate atrial fibrillation or atrial flutter.
May precipitate atrial fibrillation or atrial flutter.
Conversion of paroxysmal atrial fibrillation to chronic, incessant atrial flutter has been noted most commonly with Vaughan Williams class Ic drugs (flecainide and propafenone) and amiodarone.[5][7][8] Can occur in up to 15% to 20% of patients treated with propafenone, flecainide, and amiodarone.[2]
Atrial flutter is more common in those with a history of diabetes.[6]
Rarely, atrial flutter occurs as a result of digitalis (e.g., digoxin) toxicity.[19]
Incidence is 2.5 times higher in men than in women.[6]
This is rare.[9]
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