Atrial Flutter

What is atrial flutter?

Atrial flutter is a 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.

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 as a response, commonly as fast as 150 beats a minute or more.

Atrial flutter is like an assembly line with the speed set too fast at the 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 normal.

Atrial flutter types

• 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.

How does atrial flutter affect my body?

When you have atrial flutter, your heart isn’t working as efficiently as it should.

• Blood clots could form, which could cause a stroke or heart attack.
• The fast pulse from atrial flutter can weaken your heart muscle.
• When your heart beats too quickly, your heart ventricles can’t fill with blood. Your heart pumps less blood, which can make your blood pressure drop and cause heart failure.

What are the symptoms?

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

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

What are the complications of atrial flutter?

Complications may include:

• Fast heart rate.
• Cardiomyopathy.
• Blood clots that can travel and cause a heart attack or stroke.
• Congestive heart failure.

What causes atrial flutter?

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

Causes of atrial flutter include:

• Heart valve disorders.
• Heart condition present at birth.
• Coronary artery disease.
• High blood pressure.
• Overactive thyroid.

What are the risk factors for atrial flutter?

You’re at a higher risk of atrial flutter if you’re older, assigned male at birth or you have:

• Other heart issues, like heart failure or a valve issue.
• High blood pressure.
• A thyroid issue.
• Diabetes.
• Lung disease.
• A medical history that includes alcohol use disorder.
• Obstructive sleep apnea.
• Obesity.

How is atrial flutter diagnosed?

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

• Electrocardiogram (ECG or EKG).
• Echocardiogram.
• Blood tests.
• Pulmonary (lung) function tests.

How is atrial flutter treated?

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:

• Medicines to slow down your heart rate: Calcium channel blockers and beta-blockers.
• Medicines to stop the abnormal rhythm: Antiarrhythmic drugs.

Procedures

Procedures to treat atrial flutter include:

• Cardioversion via 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.

How can I reduce my risk?

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. These include:

• Heart valve disorders.
• Birth defect in your heart.
• Coronary artery disease.
• High blood pressure.
• Overactive thyroid.
• Obstructive sleep apnea.
• Obesity.

What can I expect if I have atrial flutter?

If atrial flutter continues, it can cause:

• Cardiomyopathy.
• Heart failure.
• Stroke.

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.

Ablation may cause complications, such as a stroke. Even after a successful ablation, 25% to 80% of people get atrial fibrillation.

How long atrial flutter lasts

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.

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 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 doctor?

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

What is the difference between atrial flutter and atrial fibrillation?

A lot of people have both atrial flutter and atrial fibrillation. Both are types of supraventricular arrhythmia. If it’s not treated, atrial flutter can actually cause atrial fibrillation and vice versa.

Atrial fibrillation characteristics

• Your top chambers (atria) beat up to 400 times a minute, causing your lower chambers to beat rapidly (up to 150 beats a minute or more).
• Your heartbeat is irregular because of disorganized electrical activity in your atria.

Atrial flutter characteristics

• Your top chambers beat up to 250 to 350 times a minute, causing your lower chambers to beat rapidly (up to 150 beats a minute or more).
• Your heartbeat is usually regular because of organized electrical activity in your atria.

A note from Cleveland Clinic

Atrial flutter is one type of fast heart rhythm in the upper part of your heart. Without atrial flutter treatment, you could be at risk for a stroke or heart failure. That’s why it’s important to keep your appointments with your healthcare provider. They can figure out your risk of stroke and offer solutions to get your heart rhythm back to normal. Your provider can help you decide which treatment is best for your situation.