Atrial Flutter

Basic Facts

  • Similar to atrial fibrillation, but with more of a pattern. 
  • Top chambers of the heart (atria) beat 2-4 times faster than bottom chambers (ventricles), but in a coordinated pattern. 
  • Symptoms, causes, diagnosis, and treatment are all the same as atrial fibrillation; however, ablations have higher success rates because it is less chaotic than atrial fibrillation. 
  • Most with atrial flutter are over age 60 and have some underlying heart disorder, such as heart valve problems or thickening of the heart muscle. 
Cardiac Ablation

As with atrial fibrillation, atrial flutter can cause a blood clot to form inside the heart, which can enter the bloodstream and result in a stroke.  

  • Underlying heart disease, hypertension, and diabetes increase the risk of stroke from atrial flutter, as does age.  

  • For this reason, medications called anticoagulants are used to help prevent clotting (commonly referred to as “blood thinners”). 

Atrial flutter may be: 

  • Paroxysmal (intermittent) – lasts from a few minutes to a few hours and resolves on its own. 

  • Persistent – lasting days, weeks, to months and requires treatment to resolve the disturbance. 

  • Permanent (chronic) – heart remains in AF and treatment is not successful to convert back to a normal rhythm. 

Symptoms can vary from person to person, from none to activity-limiting symptoms, and can include: 

  • Palpitations 

  • Fatigue 

  • Weakness 

  • Lightheadedness 

  • Shortness of breath 

  • Chest pain 

  • Obesity 

  • Sleep apnea, especially if untreated 

  • Pericarditis (inflammation of the membrane surrounding the heart) 

  • Excessive alcohol use 

  • Stimulant use, including nicotine, cocaine, amphetamines, excessive caffeine (over 400mg in a day), and cold and cough medications that contain pseudoephedrine or phenylephrine  

  • Heart valve disease 

  • Hyperthyroidism (overactive thyroid gland) 

  • Lung disease, such as COPD 

  • Pulmonary embolism (blood clot in the lung) 

  • Sick sinus syndrome (another type of heart arrhythmia) 

  • Atrial flutter may occur on an antiarrhythmic drug for the suppression of atrial fibrillation.

  • Atrial flutter may develop after an atrial fibrillation ablation, but are often amenable to ablation themselves. 

Atrial flutter is diagnosed by documenting it on an electrocardiogram (ECG) or sometimes with a holter monitor (wearable ECG worn for days). 

Treatment often includes one or more of the following: 

  • Medication(s) to control the rate and/or rhythm, such as a beta-blocker, certain calcium channel blockers, and/or anti-arrhythmics 

  • Medication to prevent blood clots leading to stroke (anticoagulants) 

  • Medical procedures including:  

    • Cardioversion – under sedation, an electrical current is applied to restore the heart’s normal rhythm 

    • Ablation – creating scarring of the areas in the heart that are causing the abnormal heart rhythm. 

    • Pacemaker implantation – controls the speed of the heart, but does not correct the AF.