Antenatal diagnosisĪFL may be diagnosed prenatally by fetal echocardiogram which will show an atrial rate of over 400 per minute and most often 2:1 AV conduction to give a ventricular rate of over 200 per minute. Differential diagnosisĭifferential diagnosis includes multifocal atrial tachycardia (see this term) and other forms of supraventricular tachycardia. The echocardiogram may show impaired ventricular function after prolonged tachycardia. The diagnosis of AFL relies on surface electrocardiogram (ECG) which usually shows an atrial rate of around 440 beats/min, most often with 2:1 atrioventricular conduction (sometimes with variable AV conduction and an irregular ventricular rate of 125-280 beats/min), and saw tooth P waves in leads II, III, and aVF. The etiology of AFL is unknown but immaturity of the myocardium and the high pressure in the right atrium during the perinatal period may be factors that favor the appearance of atrial re-entry. Some patients are asymptomatic and tachycardia may be noted on routine examination and monitoring. AFL is sustained although conversion from atrial flutter to sinus rhythm may occur spontaneously (<24 hours). AFL manifests with tachycardia and congestive heart failure. Onset during the fetal period may be associated with hydrops fetalis and death. ![]() Clinical descriptionĪFL has a neonatal onset and the majority (72%) of patients present with symptoms within the first 48 h of life. ![]() AFL is rare with an approximate incidence of around 1/50,000 live births in Europe.
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