​​What is atrial flutter?

Because of the right atrium’s shape, the electrical impulses can travel repeatedly and quickly around and around usually in a counter clockwise circle. These inappropriate, fast electrical impulses can cause the atria to beat very fast, often around 300 bpm (beats per minute).

Remember that the AV node regulates the impulses that get through to the ventricles. As a result, only about half of these fast impulses in the atria may be conducted through to the ventricles.

Therefore, if you are in atrial flutter with an atrial rate of 300 bpm, you may have a pulse or heart rate (ventricular rate) of around 150 bpm.

Atrial flutter is a kind of arrhythmia, meaning the heart is beating out of its normal rhythm. Other, less common atrial flutter types include:

• clockwise right atrial flutter
• mitral valve flutter (left atrium)
• left atrial roof flutter
  

​​​What are the symptoms of atrial flutter?

Below is a list of some of the more common symptoms people may feel when in atrial flutter:

• palpitations or fluttering in the chest
• feel dizzy or light-headed
• have chest discomfort or pain
• become short of breath
• have no energy
• may faint or pass out briefly (rare)

Some people have no symptoms.

What causes atrial flutter?

Atrial flutter is more common in people with health conditions that have caused changes in the electrical system in their heart like:

• high blood pressure
• a history of a heart attack
• a history of heart valve disease
• coronary artery disease
• lung disease
• thyroid problems
  
• previous cardiac surgery
  
• congenital heart disease
  

However, atrial flutter can also happen without any of these or other health issues. When there are no underlying health issues, it’s called primary atrial flutter.

Atrial flutter is seen more often as we get older. It’s rare in children and young adults.

For many people there isn’t anything obvious that will trigger an episode of AF. For others, triggers can be:

• caffeine
• nicotine
• alcohol
• feeling tired
• indigestion
• emotional stress
• not getting enough sleep

Two other heart arrhythmias are closely related to atrial flutter (atrial tachycardia and atrial fibrillation). Some people can have two or all three of these arrhythmias at different times.

Can atrial flutter hurt me?

This rhythm is rarely dangerous, although it can make you feel unwell. The most serious complication is a blood clot (thrombus) forming in your heart if the flutter goes on for long periods of time.

A blood clot can form inside the atria because, at a fast heart rate such as 300 bpm, the blood isn’t emptying well from these chambers. The blood then pools in the chamber and may clot.

If this clot, or a part of it, breaks off and travels in your bloodstream, it may travel to your brain and cause a stroke (which can cause brain cells to die resulting in brain damage), to your lungs and cause a pulmonary clot, or it can block the blood flow to other body organs.

Also, if your heart is allowed to beat at more than 100 bpm for weeks or months, the heart muscle may become enlarged and/or weakened. This is not always a permanent problem. It may reverse itself once the heart rate returns back to normal.

​Tests to diagnose atrial flutter

Your family doctor may order one or more of the tests below. A heart doctor (cardiologist) usually reviews the test results.

ECG or EKG – an ECG (electrocardiogram) is done by placing stickers called electrodes on the skin of your limbs and body. These electrodes are connected to a machine that creates a paper tracing of the electrical activity of your heart as the electrical impulse travels through the heart muscle.

If you’re in atrial flutter at the time the ECG is done, the tracing will show this.

Holter monitor – is a small portable monitor, connected with electrodes to your chest that you wear for 24 to 48 hours. The Holter Monitor records electrical activity of your heart as the electrical impulse travels through the heart muscle. If you go into atrial flutter while wearing the Holter monitor, this arrhythmia will be recorded.

Echocardiogram – is an ultrasound picture of the heart’s chambers. Sound waves are sent through your chest wall; the waves bounce off the structures in the heart and create a picture that shows the structure of your heart, including the pumping and valve movements.

Event recorder – similar to a Holter monitor; it’s a small portable monitor that you carry with you for 1 to 2 weeks. If you have symptoms of an abnormal rhythm, you trigger the monitor to record your heart rhythm while you are having these symptoms. This monitor is sometimes called “King of Hearts”.

Transesophageal echocardiogram (TEE) – An ultrasound camera or transducer is passed down your swallowing tube (esophagus), which sits behind the heart. This type of ultrasound picture creates clear images of the heart structure. You’ll be given medicine that makes you relax (sedation) for this procedure.

If you already have an implanted pacemaker or an internal cardiac defibrillator (ICD),these devices often store information about heart rate and arrhythmias. It may be possible for your healthcare provider to see that you have had atrial flutter or another type by looking at the information stored in these devices at your regular clinic follow-up.

Other tests to rule out underlying disease that may cause atrial flutter include blood tests, an exercise treadmill test, a cardiac Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scan, or a coronary angiogram.

​​Treatments for atrial flutter

Your treatment choices depend mainly on:​

• how long you’ve had atrial flutter
• how long it lasts
• if a cause was found
• your risk of stroke
• how much trouble your symptoms cause

Most often, treatment includes medicine that either keeps your heart in a normal rhythm or keeps your pulse at a normal rate (under 100 bpm) while the atria are in atrial flutter. Your family doctor or your heart doctor (cardiologist) will talk to you more about these medicines.

To prevent a blood clot from forming in your heart, you may be started on a blood thinner medicine. The most common one is warfarin (Coumadin^®). Other blood thinners that work as well as warfarin, have a lower risk of bleeding, and don’t need regular blood tests are also available. Please speak with your doctor or cardiologist if you’d you like to know more.

If you are prescribed warfarin, you will be asked to have a blood test (INR) done regularly to make sure the dose is right for you.

Aspirin (ASA) also works as a blood thinner and is sometimes used for people who are at a low risk of having a stroke.

If the atrial flutter can’t be managed well with medicine, your cardiologist may recommend that you have an electrical cardioversion done. This procedure is done while you’re asleep; paddles are applied to your chest and an electrical shock is delivered to your heart through your chest wall. The shock disrupts the fast atrial impulses so the SA node can take over, making your heart beat at a normal rate. The SA node is the natural pacemaker within the heart.

In some cases, you will be referred to see another cardiac specialist called an electrophysiologist. An electrophysiologist is a cardiologist with extra training in treating people with heart rhythm problems.

These doctors may have other suggestions or treatment options for people whose atrial flutter is hard to control. One of these treatments is an invasive procedure called an ablation. If this procedure is a treatment option for you, the electrophysiologist will talk to you more about it.

It’s important to talk with your doctor about your arrhythmia and treatment options if you’ve been diagnosed with atrial flutter.

Even if you have no symptoms while in atrial flutter, you may still be prescribed medicine because of the risk of stroke. If a cause is found, such as high blood pressure, you will be treated for that condition as well. Before you see your doctor, write down any questions or concerns you may have.