Definition and Overview

Atrial flutter is a type of arrhythmia that makes the heart beat up to three times the normal rate. It occurs when problems in the heart’s electrical system and impulses cause the atria and ventricles to be out of sync. To fully understand this disorder, it helps to know how the heart and its electrical system work.

The heart’s electrical system is what makes it pump so blood will flow to the rest of the body. The organ has a natural pacemaker that fires electrical impulses to make the atria contract. These impulses slow down before they move to the ventricles, which then contract to push the blood out of the heart.

With atrial flutter, this electrical impulse goes faster and in circles around the atrium. Doctors often describe this as “like a dog chasing its own tail.” This makes the atria contract much faster than normal or up to 250 to 300 beats per minute. When this happens, the AV node (the heart’s natural pacemaker) blocks some of the impulses in an attempt to control the heart rate. This causes the ventricles and atria to pump at different speeds, which results in faster contractions.

Atrial flutter is very similar to atrial fibrillation (AF), which is another common heart rhythm disorder. Both make the heart beat faster, but unlike AF, the rhythm in the atria is less chaotic in atrial flutter. In fact, it makes a very distinct sawtooth pattern on an electrocardiogram.

Many people with atrial flutter live full and active lives. Most of them do not have other symptoms other than faster than normal heart rate that tends to come and go. However, doctors still recommend treating their disorder because it can damage the heart muscle if left untreated. One of the serious possible outcomes of atrial flutter is heart failure or when the heart stops working properly that it can no longer pump enough blood to the rest of the body. Also, the condition increases the risk of blood clots because it causes the blood to move more slowly. Blood clots can cause serious problems because they can travel through the bloodstream and get stuck in major arteries. When this happens, the blood will not reach the brain, lungs, and other organs. This puts the patient at risk of stroke, heart attack, and pulmonary embolism.

Causes

Atrial flutter can occur when blood flow to the heart is blocked or obstructed. This can happen if a person has:

  • Atherosclerosis, or when plaque builds up inside the arteries

  • High blood pressure

  • Cardiomyopathy, a heart disorder that makes the heart muscle too stiff or thick

  • Heart valve abnormalities

  • Overactive thyroid gland

  • Blood clots stuck in major arteries

  • Chronic lung diseases

Key Symptoms

The common symptoms of atrial flutter are:

  • Anxiety

  • Chest pain

  • Confusion

  • Tiredness when exercising

  • Fast heart rate

  • Dizziness

  • Low blood pressure

  • Shortness of breath

  • Sweating

Atrial flutter and its symptoms are seldom serious. Many patients feel fine and are able to go about their work and life as normal.

Who to See and Types of Treatments Available

Patients with signs of atrial flutter can consult a general practitioner (GP) for assessment. If the results of initial tests suggest a heart problem, the patient will be referred to a heart specialist. Some of the tests that will be done to diagnose the disorder are:

  • Electrocardiogram (ECG) - ECG measures and records the heart’s electrical impulses. It can detect conduction abnormalities as well as signs of many heart problems.

  • Echocardiogram - A type of ultrasound test that uses sound waves to make detailed pictures of the heart. It helps doctors easily find problems of the heart and its valves. It can also show if the patient has blood clots.

  • Holter monitor - A device that a patient wears to continuously record their heart rhythm for 24 to 72 hours. This helps doctors identify heart rhythm abnormalities.

Treatment

Atrial flutter is treated with:

  • Medications - Patients are given medications that control heart rhythm and prevent blood clots from forming. They are also often prescribed with calcium and beta-blockers to slow down the conduction through the AV node.

  • Catheter ablation - This procedure uses heat to destroy the heart tissue that causes atrial flutter. It uses thin, flexible wires (catheters) that are threaded through a vein in the groin or neck to the heart.

  • Cardioversion - Uses electrodes to send shocks to the heart to restore normal heart rhythm.

The methods used to treat atrial flutter are very safe and effective. In many cases, they resolve the problem without causing side effects or complications. The prognosis is usually very good if the disorder is diagnosed and treated early. If the disorder is caught when complications have already occurred, advanced and more invasive treatments are needed to manage the condition.

References:

  • Granada J, Uribe W, Chyou PH, Maassen K, Vierkant R, Smith PN, et al. Incidence and predictors of atrial flutter in the general population. J Am Coll Cardiol. 2000 Dec. 36(7):2242-6

  • Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW, et al. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010 Nov 2. 122(18 Suppl 3):S729-67.

  • Falk RH, Pollak A, Singh SN, Friedrich T. Intravenous dofetilide, a class III antiarrhythmic agent, for the termination of sustained atrial fibrillation or flutter. Intravenous Dofetilide Investigators. J Am Coll Cardiol. 1997 Feb. 29(2):385-90.

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