Atrial flutter pacemaker

Common supraventricular tachycardias requiring drug treatment are atrial fibrillation (AF) or atrial flutter, paroxysmal supraventricular tachycardia (PSVT), and automatic atrial tachycardias. Other common supraventricular arrhythmias that usually do not require drug therapy are not discussed in this chapter (e.g., premature atrial complexes, wandering atrial pacemaker, sinus arrhythmia, sinus tachycardia). 

An elderly man with long standing brady-tachycardia was successfully treated for atrial flutter firstly with a temporary pacemaker (later withdrawn) and 600 mg amiodarone daily. Ten days later, and 25 minutes after a permanent pacemaker was inserted under local anaesthesia with 15 mL of 2% lidocaine, severe sinus bradycardia and long sinoatrial arrest developed. He was effectively treated with atropine plus isoprenaline, and cardiac massage. ... 

Another use for defibrillators is to shock either atrial flutter or fibrillation, which are abnormally rapid atrial rhythms. These atrial rhythms are much less likely to spontaneously proceed rapidly to death than ventricular arrhythmias. Using electrical shock to treat rapid heart arrhythmias other than VF is usually referred to as cardioversion and hence some users refer to the tachycardia treatment devices as cardioverter—defibrillators. Cardiovertor and defibrillator treatment is different from pacemaker treatment (discussed elsewhere in this book) because a pacemaker stimulates a slowly beating heart and uses much weaker shocks. Pacemaking increases the rate of the relatively healthy heart, which increases blood flow. 

Fig. 12.2 An example of atrial fibrillation (AF) organizing into atrial flutter. A. The upper strip in the top panel demonstrates the atrial electrogram (EGM) and the lower strip demonstrates the annotated markers indicating how the pacemaker classifies each atrial and ventricular event as well as the cycle length (in ms) between each interval. The atrial electrogram shows the rapid irregular atrial rhythm which subsequently transitions into an organized atrial tachycardia. B. Atrial antitachycardia pacing (ATP) therapy - a burst train followed by two premature extrastimuli is delivered restoring atrial paced rhythm. The marker channel notations indicate how the device classifies each beat. Inter-beat intervals are also shown (in ms). AP - atrial paced event VP - ventricular paced event AR - atrial event sensed in atrial refractory period FS - AF sensed event TD - tachycardia detected TS - tachycardia sensed event. Courtesy AM Gillis.

Contraindications Atrial fibrillation or flutter, second-or third-degree AVblock or sick sinus syndrome (with functioning pacemaker), ventricular tachycardia... 

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