An Overview of Atrial Flutter

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Atrial flutter is a cardiac arrhythmia—a condition defined by an abnormal heart rhythm. More specifically, it is an arrhythmia that typically causes tachycardia (a fast heart rate) and palpitations.

Atrial flutter is caused by the formation of extremely rapid, abnormal electrical impulses arising in the atria of the heart. Typically, about half of these impulses are transmitted to the ventricles, producing a heart rate that is usually around 150 beats per minute.

Doctor showing patient ECG results on a tablet
Ariel Skelley/Blend Images/Getty Images

The condition is related in many ways to atrial fibrillation, the more well-known arrhythmia. Because flutter originates in the atria, it is considered a form of supraventricular tachycardia.

While atrial flutter itself is usually not life-threatening, it can significantly increase a person’s risk of having a stroke.

Overview

Atrial flutter is a type of reentrant arrhythmia; it occurs when an electrical impulse becomes “trapped” in a circuit within the heart and begins spinning around and around. With atrial flutter, the reentrant circuit is a relatively large one that is usually located within the right atrium and typically follows a characteristic path.

Because the circuit responsible for atrial flutter is usually well-defined, this makes atrial flutter particularly suitable for ablation therapy. By creating a blockage in a particular location within that characteristic path, the reentrant circuit can be disrupted and the atrial flutter can cease.

Atrial Flutter Symptoms

The rapid heart rate commonly produced by atrial flutter most often leads to pronounced symptoms including:

  • Palpitations
  • Dizziness
  • Fatigue
  • Change in mental status
  • Dyspnea (breathlessness)

Like most reentrant arrhythmias, episodes of atrial flutter tend to come and go quite suddenly and unexpectedly.

If a person with atrial flutter also has coronary artery disease, the rapid heart rate can place enough stress on the cardiac muscle to cause angina. Severe chest pain is the classic symptom.

Atrial flutter can also produce a sudden worsening of symptoms in people who have heart failure.

Relevance

Because the symptoms it produces can be intolerable, atrial flutter would be a significant arrhythmia even if all it did was cause uncomfortable symptoms.

But the biggest problem with atrial flutter is that, as is the case with atrial fibrillation, this arrhythmia tends to cause blood clots (thrombus formation) in the atria. These blood clots can break loose (embolize) and cause strokes.

Furthermore, atrial flutter often tends to be a “bridge arrhythmia” to atrial fibrillation. That is, people with atrial flutter often go on to develop chronic atrial fibrillation.

Risk Factors

While anyone can develop atrial flutter, it is not a common arrhythmia. It is much less frequent, for instance, than atrial fibrillation.

The people most likely to develop atrial flutter are the same ones also most likely to develop atrial fibrillation. These include people to whom any of the following apply:

Diagnosis

Diagnosing atrial flutter is fairly straightforward. It merely requires capturing the arrhythmia on an electrocardiogram (ECG) and looking for what are called “flutter waves.”

Flutter waves are signals appearing on an ECG that represent the electrical impulse that is spinning around the atrial reentrant circuit.

Treatment

The goals of treatment for atrial flutter are to regulate your heart rate, reduce the risk of heart failure or stroke, and relieve any symptoms you may be experiencing.

The right treatment option for you depends on several factors, including:

  • Whether or not your atrial flutter is caused by an underlying condition
  • What symptoms you are experiencing and how they impact you
  • Your risk level for having a stroke

There are several treatment options available that may be used to stop an acute episode or prevent episodes from recurring.

Stopping an Atrial Flutter Episode

In people who are having an acute episode, atrial flutter can be stopped quite readily with electrical cardioversion or by acutely administering antiarrhythmic drugs (usually, ibutilide or dofetilide).

If symptoms are severe during an acute episode, slowing the heart rate may be necessary while making preparations for cardioversion. This can often be accomplished quickly by administering intravenous doses of the calcium blockers diltiazem or verapamil, or the rapidly-acting intravenous beta blocker esmolol.

These drugs must be used cautiously, however, in people who also have heart failure.

Preventing Further Episodes

Once an acute episode has been dealt with, the next step is to attempt to suppress additional ones. In this regard, it is important to look for and treat any reversible underlying cause, such as hyperthyroidism, sleep apnea, or obesity.

Hyperthyroidism can usually be sufficiently controlled within a few days. Sleep apnea is also generally treatable within a reasonable period of time.

While obesity is also a reversible cause of atrial flutter, practically speaking, it is often not reversed sufficiently or quickly enough to assist substantially in treating this arrhythmia. Because of this, means beyond weight loss must be used to control atrial flutter.

If no readily reversible cause is found, treatment aimed directly at preventing atrial flutter is necessary. This will consist either of suppressing the arrhythmia with drugs or using ablation therapy.

Antiarrhythmic drugs have a poor success rate with atrial flutter, but the opposite is true for ablation (rhythm control). For this reason, and because of the many toxicities common with antiarrhythmic drug therapy, ablation therapy is by far the treatment of choice for most people who have atrial flutter.

Fortunately, ablating atrial flutter is usually a relatively straightforward procedure with a very favorable rate of success (well over 90%). However, there is a 10% to 33% chance of the flutter returning or atrial fibrillation occurring after ablation of the most common type of atrial flutter.

Nevertheless, In the large majority of people who have this arrhythmia, ablation ought to be strongly considered.

Since ablation works so well, resorting to a “rate-control strategy” (commonly used for atrial fibrillation) is only rarely necessary for atrial flutter. A rate control strategy means allowing the arrhythmia to occur and attempting to control the resulting heart rate in order to minimize symptoms.

Controlling the heart rate in atrial flutter is substantially more difficult than it is with atrial fibrillation. It commonly requires the use of a combination of beta-blockers and calcium blockers.

On occasion, getting the heart rate under control means ablating the heart’s normal conducting system to create heart block, then insert a pacemaker to establish a stable heart rate. Often, getting rid of the atrial flutter altogether with an ablation procedure is the preferable course of action.

In any case, however, chronic anticoagulation therapy may be recommended to prevent stroke based on a person's unique risk factors, just as with atrial fibrillation.

A Word From Verywell

Atrial flutter is a relatively uncommon cardiac arrhythmia that is related to atrial fibrillation. The two are similar in that they produce uncomfortable symptoms and increases a person’s risk of stroke. However, in contrast to atrial fibrillation, ablation therapy for atrial flutter is usually quite straightforward and generally can be accomplished with a high rate of success.

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