What is atrial flutter?
In atrial flutter, your heart’s upper chambers (atria) beat too quickly. This causes the heart to beat in a fast, regular rhythm.
Atrial flutter is a type of heart rhythm disorder (arrhythmia) caused by problems in your heart’s electrical system.
Atrial flutter is similar to atrial fibrillation, a common heart rhythm disorder. However, the rhythm in your atria is more organized and less chaotic in atrial flutter than are the abnormal patterns common with atrial fibrillation. Sometimes you may have periods of both atrial flutter and atrial fibrillation.
How common is atrial flutter?
Atrial flutter can affect patients at any age. It can be managed by reducing your risk factors. Please discuss with your doctor for further information.
What are the symptoms of atrial flutter?
The electrical signal that causes atrial flutter circulates in an organized, predictable pattern. This means that people with atrial flutter usually continue to have a steady heartbeat, even though it is faster than normal. It is possible that people with atrial flutter may feel no symptoms at all. Others do experience symptoms, which may include:
- Heart palpitations (feeling like your heart is racing, pounding, or fluttering)
- Fast, steady pulse
- Shortness of breath
- Trouble with everyday exercises or activities
- Pain, pressure, tightness, or discomfort in your chest
- Dizziness, lightheadedness, or Fainting
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes atrial flutter?
Atrial flutter may be caused by abnormalities or diseases of the heart, by a disease elsewhere in the body that affects the heart, or by consumption of substances that change the way electrical impulses are transmitted through the heart. In some people, no underlying cause is ever found.
Heart diseases or abnormalities that can cause atrial flutter include the following:
- Decreased blood flow to the heart (ischemia) due to coronary heart disease, atherosclerosis, or a blood clot
- High blood pressure (hypertension)
- Disease of the heart muscle (cardiomyopathy)
- Abnormalities of the heart valves (especially the mitral valve)
- An abnormally enlarged chamber of the heart (hypertrophy)
- After open heart surgery
Diseases elsewhere in the body that affect the heart include the following:
- Overactive thyroid gland (hyperthyroidism)
- Blood clot in a blood vessel in the lungs (pulmonary embolism)
- Chronic (ongoing, long-term) lung diseases (COPD), such as emphysema, that lower the amount of oxygen in the blood
Substances that may contribute to atrial flutter include the following:
- Alcohol (wine, beer, or hard liquor)
- Stimulants such as cocaine, amphetamines, diet pills, cold medicines, even caffeine
Atrial flutter is closely related to atrial fibrillation. The two sometimes alternate back and forth.
What increases my risk for atrial flutter?
There are many risk factors for atrial flutter, such as:
- Heart failure
- Previous heart attack
- Valve abnormalities or congenital defects
- High blood pressure
- Recent surgery
- Thyroid dysfunction
- Alcoholism (especially binge drinking)
- Chronic lung disease
- Acute (serious) illness
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is atrial flutter diagnosed?
Upon hearing your symptoms, your health care provider (whether a primary care provider or the provider in the emergency department) will probably suspect an arrhythmia. Because other conditions can cause similar symptoms, the evaluation will at first focus on ruling out the most dangerous ones. Fortunately, there is one simple test that can tell quite a lot about what is happening with the heart:
The ECG measures and records the electrical impulses that control the beating of the heart.
- The ECG highlights irregularities in these impulses and abnormalities in the heart.
- In arrhythmias, the ECG tracings can help pinpoint the type of arrhythmia and where in the heart it comes from.
- ECG also shows signs of heart attack, heart ischemia, conduction abnormalities, abnormal heart enlargement (hypertrophy), and even certain chemical abnormalities in the heart tissue such as potassium and calcium.
People sometimes have symptoms suggesting atrial flutter, but their ECG result in the emergency department or medical office is normal. Ambulatory ECG involves wearing a monitoring device for a few days while you go about your normal activities.
- The device, also known as a Holter monitor, is usually worn around your neck. ECG electrodes are worn on the chest.
- Typically, the device records your heart rhythm on a continual basis for 24-72 hours.
- Some health care providers prefer that you wear the device for a longer time, with intermittent recording of your heart rhythm. This is called an event recorder, which you can turn on when you feel something abnormal. More rarely, an event recorder can be implanted under the skin and worn for several weeks or months.
- Either method works well. The important thing is to get ECG documentation of your arrhythmia.
Echocardiogram: This is a painless ultrasound test that uses sound waves to make a picture of the inside of the heart while it is beating and between beats.
- This test is done to identify heart valve problems, check ventricular function, or look for blood clots in the atria.
- This very safe test uses the same technique used to check a fetus in pregnancy.
- This test is not always done in the emergency department.
How is atrial flutter treated?
The goals of treatment for atrial flutter are to control the heart rate, restore normal sinus rhythm, prevent future episodes, and prevent stroke.
Control rate: The first treatment goal is to control the ventricular rate.
- If you experience serious symptoms, such as chest pain or congestive heart failure related to the ventricular rate, the health care provider in the emergency department will decrease your heart rate rapidly with IV medications or electrical shock (called cardioversion or defibrillation).
- If you have no serious symptoms, you may be given medications by mouth.
- Sometimes you may require a combination of oral drugs to control your heart rate.
- Surgery may be done to control heart rate or rhythm, but this is rare.
- Restore and maintain normal sinus rhythm: Some people with newly diagnosed atrial flutter convert to normal sinus rhythm spontaneously in 24-48 hours. The goal of treatment is to convert the atrial flutter to normal sinus rhythm and prevent recurrence of atrial flutter.
Not everyone with atrial flutter needs anti-arrhythmic medication.
- The frequency with which your arrhythmia returns and the symptoms it causes partly determine whether you receive anti-arrhythmic drugs.
- Medical professionals carefully tailor each person’s anti-arrhythmic medication(s) to produce the desired effect without creating unwanted side effects, some potentially lethal.
Prevent future episodes: This is usually done by taking daily medication to keep the heart at a safe and comfortable rate.
- Coexisting medical conditions, such as congestive heart failure and mitral valve disease, significantly increase the risk of stroke.
- Patients with persistent atrial flutter need a “blood-thinning” drug called warfarin to lower this risk. Warfarin blocks a certain factor in the blood that promotes clotting. Other blood thinners called Pradaxa (dabigatran), Eliquis (apixaban), and Xarelto (rivaroxaban) have been approved by the FDA to prevent stroke in people with atrial fibrillation.
- People at lower risk of stroke and those who cannot take warfarin may use aspirin. Aspirin is not without its own side effects, including bleeding problems and stomach ulcers.
The choice of medication depends on the frequency of atrial flutter, the underlying cause, your other medical conditions and overall health, and the other drugs you take. The classes of medications used in atrial flutter are as follows:
- Anti-arrhythmic medications: These drugs are used to chemically convert atrial flutter to normal sinus rhythm, reduce the frequency and duration of atrial flutter episodes, and prevent future episodes. They are often given to prevent return of atrial flutter after cardioversion. Examples are amiodarone, sotalol, ibutilide, propafenone, and flecainide.
- Digoxin (Lanoxin): This drug decreases the conductivity of electrical impulses through the SA and AV nodes, slowing down the heart rate.
- Beta-blockers: These drugs decrease the heart rate by slowing conduction through the AV node, plus they have a direct anti-arrhythmic effect on the atria.
- Calcium channel blockers : These drugs also slow down the heart rate by slowing conduction through the AV node.
- Anticoagulants: These drugs reduce the ability of the blood to clot, thus reducing the risk of an unwanted blood clot forming in the heart or in a blood vessel. Atrial flutter increases the risk of forming such blood clots.
Lifestyle changes & Home remedies
What are some lifestyle changes or home remedies that can help me manage atrial flutter?
The following lifestyles and home remedies might help you cope with atrial flutter:
- Make healthy lifestyle choices. Living a “heart healthy” life is the best way to reduce the chances of developing heart disorders. Exercising regularly, maintaining a healthy weight, and eating a healthy, low-fat diet with plenty of vegetables, fruits, and other vitamin-rich foods are the cornerstones of “heart healthy” living.
- Stop smoking and avoid secondhand smoke (smoke from other people). Tobacco contributes to as much as one-third of all heart disease.
- Avoid or limit the intake of caffeine, alcohol, and other substances that may contribute to abnormal heart rhythms or heart disease.
- Avoid unnecessary stress, such as anger, anxiety, or fear, and find ways to manage or control stressful situations that cannot be avoided.
- Have regular physical exams and tell your doctor right away about any unusual symptoms you have.
- Talk to a doctor about treating health problems that may contribute to abnormal heart rhythms and heart disease, including atherosclerosis (“clogged” arteries), heart valve damage, High Blood Pressure, high cholesterol, diabetes, and thyroid disease.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
- atrial flutter. http://www.hrsonline.org/Patient-Resources/Heart-Diseases-Disorders/Atrial-Flutter. Accessed 3 Mar 2017
- atrial flutter. http://www.webmd.com/heart-disease/atrial-fibrillation/atrial-flutter#1. Accessed 3 Mar 2017
- Atrial flutter. http://www.mayoclinic.org/diseases-conditions/atrial-flutter/basics/definition/con-20032957. Accessed 3 Mar 2017
Review Date: July 24, 2017 | Last Modified: July 24, 2017