Atrial Flutter

What is atrial flutter?

Atrial flutter is one of the more common abnormal heart rhythms (arrhythmias). It's caused by an abnormal electrical circuit in the upper chambers of the heart (atria) that makes the atria beat quickly and flutter instead of fully squeezing. It can result in fast heart rates and a heart that doesn't work as well as it should. This increases the risk for stroke and may cause you to feel poorly.

What causes atrial flutter?

In a normal functioning heart, electrical impulses are sent out from the sinus node (SA node) in the right atrium. This node controls the heart rate and timing of heartbeats. The electrical impulses travel through the heart muscle in the atria. This triggers the muscle to squeeze. In atrial flutter, an abnormal electrical circuit forms in the atria. This causes abnormally frequent contractions in the upper chambers. This new circuit takes over the heart rhythm and rate. It may cause the lower chambers of the heart (ventricles) to beat fast too, but often not as fast as the atria. This often happens after some types of heart surgery, heart muscle damage, or other heart changes.

Who is at risk for atrial flutter?

You are more likely to have atrial flutter if any of these apply to you:

• Age. The older you are, the higher the risk.

• High blood pressure

• Diabetes

• Coronary artery disease

• Heart failure

• Heart valve disease

• Congenital heart disease

• Past heart surgery

• Obesity

• Alcohol consumption

• Lung disease

• Overactive thyroid (hyperthyroidism)

• Sleep apnea

• Overexercising, such as in endurance athletes

• Family history

What are the symptoms of atrial flutter?

Atrial flutter can reduce the forward pumping of the heart. It can make the heart beat abnormally fast. But some people have no or minor symptoms. This is true if their heart rate is controlled and their heart otherwise works as it should. If you do have symptoms, they can include:

• Shortness of breath

• Tiredness (fatigue)

• Chest pain

• Fluttering heartbeats (palpitations)

• Lightheadedness

• Fainting

• Swelling in your feet and legs (fluid retention) if you have heart failure

How is atrial flutter diagnosed?

To diagnose atrial flutter, your healthcare provider will want to record your heart rhythm. This may include:

• Electrocardiography (ECG). This measures the electrical activity in your heart through tiny patches placed on your chest and limbs. The patches are connected to a machine that records the heart rate and rhythm.

• Holter monitoring. This is a portable ECG that you can wear to record your heart rhythm for 24 hours, or longer. Some models can be worn for several weeks.

• Event monitoring. This type of ECG samples your heart rate over several days to weeks

It can be hard to capture atrial flutter if it happens on and off or only lasts a few minutes. The longer the recording time of heart rhythm, the higher the chance atrial flutter can be recorded.

In some cases, an implanted monitor (loop recorder) can be surgically placed underneath the skin over the heart. This can stay in place for up to 3 years of continuous heart monitoring.

How is atrial flutter treated?

The goal of treatment is to control the heart rate, prevent stroke, and maintain a normal heart rhythm.

• To control heart rate, you may be given a prescription medicine that can slow down the heart rate.

• To prevent stroke, your healthcare provider may prescribe a blood thinner (anticoagulant) to prevent a blood clot in the heart. A clot can form because blood can pool in the fluttering atria instead of being pumped out normally. This clot can break free and travel to the brain.

Rhythm control involves either medicine or a procedure:

• Antiarrhythmics. These medicines can be taken as needed to stop an episode. Or you can take them every day to prevent future atrial flutter.

• Electrical cardioversion. This is an outpatient procedure where large electrode patches are placed on your chest and back. Energy is sent through these patches as a shock that is synchronized with your heartbeat. In many cases, this restores normal rhythm. This is typically done with IV sedation so that the shock is not felt. Sometimes your healthcare provider may start you on an antiarrhythmic medicine around the time of the cardioversion. This helps maintain a normal rhythm for a longer period of time after cardioversion. Or it may help the cardioversion to be a success.

• Cardiac ablation. This is a nonsurgical, catheter-based procedure that can often cure atrial flutter. It involves threading wires through a vein in your leg to the heart. Either heat energy or cold energy is used to destroy the abnormal circuit.

The success rate of each treatment varies. Discuss this with your healthcare provider.

What are possible complications of atrial flutter?

Although atrial flutter is usually not life-threatening at first, it does limit how well your heart pumps blood. This can cause a clot to form in your heart. If the clot breaks loose, it could lead to a stroke.

Over time, atrial flutter can weaken your heart muscle. This can lead to heart failure. Atrial flutter is often linked to a similar heart rhythm called atrial fibrillation (AFib). AFib is the most common type of arrhythmia.

Can atrial flutter be prevented?

Prevention of atrial flutter focuses on controlling or preventing the risk factors.

• Stay at a healthy weight.

• Drink alcohol only in moderation, if at all.

• Stop tobacco use.

• Control high blood pressure and diabetes.

When should I call my healthcare provider?

Although most often not immediately life-threatening, complications of atrial flutter can be serious if left untreated. See your healthcare provider if you notice any of the possible symptoms of atrial flutter.

Key points about atrial flutter

• Atrial flutter is a common type of heart arrhythmia.

• You may have no symptoms.

• If present, symptoms may include a noticeable fast, steady or irregular pulse, shortness of breath, dizziness, trouble with normal activities or exercise, a feeling that your heart is pounding, or tightness in your chest.

• Medicines are available to help control your heart rate, maintain normal heart rhythm, and reduce stroke risk.

• A procedure called catheter ablation can cure atrial flutter.

• Complications from atrial flutter can be life-threatening if the condition is not treated

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions.