Atrial Flutter

What is atrial flutter?

Atrial flutter is a common type of supraventricular arrhythmia. This means it’s an abnormal heart rhythm that starts in the upper chambers of your heart. With atrial flutter, your heart beats in a fast but consistent pattern. Faulty electrical signals cause this to happen.

A normal heart rate is 60 to 100 beats a minute when you’re at rest. Atrial flutter can make your heart’s upper chambers beat 250 to 350 times a minute. This causes your lower chambers to beat fast in response, commonly as fast as 150 beats a minute or more.

Types of atrial flutter

• Typical (most common type): Abnormal electrical signals go in a counterclockwise circle in your right atrium.
• Reverse typical: Abnormal electrical signals move in a clockwise direction in your right atrium.
• Atypical (not common unless you’ve had heart surgery or ablations before): Abnormal electrical signals can happen in your left or right atrium.

A provider can tell which type of atrial flutter you have based on your electrocardiogram (EKG) results.

What are the symptoms?

Some people don’t have atrial flutter symptoms. For others, symptoms include:

• Shortness of breath (dyspnea)
• Dizziness
• Lack of energy
• Heart palpitations
• Fast pulse
• Chest pain
• Passing out
• Lightheadedness

What causes atrial flutter?

Electrical signals that are too frequent cause atrial flutter, making the upper chambers of your heart contract (pump) too often.

Atrial flutter causes include:

• Heart valve disorders
• Congenital heart conditions (present at birth)
• Coronary artery disease
• Heart failure
• High blood pressure
• Overactive thyroid

What are the risk factors?

Your risk of atrial flutter increases as you age. You’re also at a higher risk if you’re assigned male at birth (AMAB).

Medical conditions that can raise your risk include:

• Other heart issues, like heart failure or a valve issue
• High blood pressure
• A thyroid that isn’t working right (hyperthyroidism)
• Diabetes
• Lung disease
• A history of alcohol use disorder
• Obstructive sleep apnea
• Obesity

What are the complications of atrial flutter?

When you have atrial flutter, your heart isn’t working as efficiently as it should. Blood flow through your heart is like an assembly line. Blood moves from one chamber to the next before leaving your heart.

But atrial flutter is like having the speed set too fast at an assembly line’s first station. Your heart’s chambers can’t fill with blood fast enough because the contractions are too frequent. Also, there isn’t enough time for your atria (upper chambers) to empty all their blood into your ventricles in the lower part of your heart. This causes your heart to pump less blood to your body than it should.

• Some blood stays in your atria because there isn’t time for all of it to move out. Blood clots could form in blood that sits. These clots could cause a stroke or heart attack.
• The fast pulse from atrial flutter can weaken your heart muscle (cardiomyopathy).
• When your heart beats too quickly, your ventricles can’t fill with blood. Your heart pumps less blood, which can cause heart failure.

How is it diagnosed?

A provider may use tests to diagnose atrial flutter, including:

• Electrocardiogram (ECG or EKG). This test creates a graph of your heart rhythm. If you have atrial flutter, the lines on the graph will look like a sawtooth or picket fence pattern.
• Echocardiogram. This can show blood clots in your atria and allow your provider to look at the condition of various parts of your heart.
• Blood tests. These can check for an overactive thyroid, electrolyte imbalance or other issues.
• Pulmonary (lung) function tests. These assess how well your lungs work.

How is atrial flutter treated?

Atrial flutter treatment may begin with treating the condition that caused it. Treatment for atrial flutter itself includes medications and procedures.

Medicines work well for many people with atrial flutter. Any medicine can have side effects, but the benefits usually are greater than the risks. When medicines don’t work, your provider may recommend a procedure that can help.

Medications

Medicines for the treatment of atrial flutter include drugs that:

• Slow down your heart rate (calcium channel blockers and beta-blockers)
• Stop the abnormal rhythm (antiarrhythmic drugs)
• Prevent blood clots (anticoagulants)

Procedures

Procedures to treat atrial flutter include:

• Cardioversion using medicine or electrical shock
• Catheter ablation, a procedure a provider can use to destroy the tissue that’s creating abnormal signals
• Temporary change in your pacemaker or implantable cardioverter defibrillator (ICD) setting

Complications of the treatment

Rarely, you can have complications from an ablation, including:

• Infection
• Bleeding
• Injury to a blood vessel
• Blood clots
• Stroke

How successful are the treatments?

Cardioversion works in 70% to 90% of people. Some people have less than a 5% chance of atrial flutter happening again after a catheter ablation. Others may have less successful procedures because of their type of atrial flutter. People with complex cases of atypical atrial flutter may have only a 70% success rate with ablation.

How long does it take to recover from this treatment?

After having an ablation, you can expect to have some limits for the first week. This means waiting a week before you drive a vehicle or lift more than 10 pounds.

Can atrial flutter be prevented?

Although you can’t prevent some of the risk factors for atrial flutter, limiting your alcohol intake can help. Also, you can get medical care for the problems that cause atrial flutter or put you at risk for it

What can I expect if I have atrial flutter?

Because there’s no cure for atrial flutter and it carries a high risk of stroke, you’ll need follow-up appointments all your life. It’s important to keep your appointments because it’s common for atrial flutter to keep coming back. People with atrial flutter may have multiple hospital visits because of this.

How do I take care of myself?

Make sure you keep your follow-up appointments with your healthcare provider. Each year, they’ll figure out your stroke risk based on other medical conditions you may have. You may need to take an anticoagulant if your provider believes you’re at risk of a stroke.

When should I see my healthcare provider?

You’ll have regular visits with your provider to catch any complications that may happen. Also, your provider may repeat tests they used to diagnose you. Contact your provider if you experience a reaction to a medication or if your symptoms change or worsen.

When should I go to the ER?

You should seek medical care when you have a fast heartbeat (150 beats per minute or more) while at rest.

What questions should I ask my healthcare provider?

Questions to consider asking your provider may include:

• Do I have atrial flutter or another type of arrhythmia?
• What’s the best treatment for me?
• What’s my risk of stroke?

Is atrial flutter dangerous?

Atrial flutter isn’t life-threatening, but it is serious. If you don’t treat atrial flutter, you may have life-threatening complications. For example, you may have a stroke or heart attack.