Hemodynamically stable вЂ“ diagnostic use of adenosine and pharmacological termination or cardioversionДЄdenosine is useful for diagnostic purposes, - by decreasing atrioventricular (AV) nodal conduction with a vagotonic maneuver or with adenosine the atrial F waves are revealed ! AV node is not involved in the flutter circuit > adenosine does not terminate the rhythmВ !.Hemodynamically unstable patient вЂ“ urgent synchronized cardioversion.In some cases, electrophysiological study is the only way to find the mechanism causing atypical flutter and plan an ablation, when needed.Дecreasing atrioventricular (AV) nodal conduction physiologically with a vagotonic maneuver (such as the Valsalva maneuver or carotid sinus massage) or with a rapidly acting drug (such as adenosine, verapamil, or esmolol) will increase the AV nodal block and reveal the atrial F waves. Left atrial atypical flutters have circuits around electrically silent areas of abnormal tissue, following medical interventions or progressive atrial degeneration/fibrosis (AF ablation, surgery for different conditions with incisions or cannulation). Rate control is often difficult due to the regularity and usually slow rate of the tachycardia. Right atrial atypical flutter is associated with atrial sutures and patches used for complex congenital heart disease surgery or following surgical atriotomy. Upper loop re-entry (right atrium) - positive F waves in the inferior leads and negative, flat, or barely positive F waves in lead I. Lower loop re-entry (around the inferior vena cava) - negative F waves in the inferior leads Left atrial flutters вЂ“ variable morphology - positive or isoelectric F waves in V1 - often positive F waves in the inferior leads II, III, aVF Right atrial flutters вЂ“ negative F wave in V1 P waves are absent - F waves are regular, but there may be an isoelectric appearance between F waves - No clear F wave morphology - atrial scar can alter conduction velocity and direction The most frequent left atrial flutters are perimitral, peripulmonary veins, septal, roof and posterior wall macro reentry. Atypical left atrial flutters вЂ“ left atrial macroreentry (anatomic obstacle like the mitral annulus), post-ablation AF (incomplete ablation lines from either a transvenous catheter ablation or a surgical Maze procedure).Atypical right atrial flutters - lesion macroreentrant tachycardia (an atriotomy scar or suture line can act as an obstacle to conduction and create reentry вЂ“ most common) or non-atriotomy related right atrial flutter (areas of low voltage in the right atrium).Atypical atrial flutter is a type of supraventricular tachycardia which originates from a macro-re-entrant circuit in the atria that does not involve the CTI (cavotricuspid isthmus) with ECG patterns differing from the counterclockwise and clockwise typical flutter

Atypical atrial flutter icd 10