What Is Atrial Flutter?
Atrial flutter is the second most common type of abnormal heart rhythm where the upper chambers of the heart (atria) beat too quickly and in a regular pattern-around 300 times per minute instead of the usual 60 to 90. This is due to a problem with the heart’s electrical signals. This rapid rhythm can affect how well the heart pumps blood and may lead to symptoms or complications similar to atrial fibrillation (AFib), though the two conditions are different. It most often affects people over the age of 60 and is frequently associated with underlying heart valve disorders or chronic lung conditions.
How Is Atrial Flutter Different from Atrial Fibrillation?
While both are atrial arrhythmias:
- Atrial fibrillation causes an irregular and chaotic rhythm.
- Atrial flutter causes a fast but regular rhythm— around 300 times per minute instead of the usual 60 to 90.
In some people, atrial flutter and atrial fibrillation can occur alternately or even simultaneously.
Symptoms of Atrial Flutter
Symptoms vary but may include:
- A fast, steady heartbeat or palpitations
- Shortness of breath
- Dizziness or lightheadedness
- Fatigue or reduced ability to exercise
- Chest discomfort
Some people may not feel any symptoms at all.
What Causes Atrial Flutter?
Atrial flutter can occur in healthy hearts but is often linked to underlying heart or health conditions, including:
- High blood pressure
- Cardiomyopathy – typically leads to enlargement of the atria
- Heart failure
- Coronary artery disease
- Heart valve disease
- Congenital heart disease
- Previous heart surgery
- Chronic lung disease- including COPD
- Thyroid disorders
- Excessive alcohol or stimulant use
- Myocarditis (heart inflammation)
Diagnosis
To diagnose atrial flutter, your cardiologist may order:
- Electrocardiogram (ECG) – the key test to identify the flutter pattern
- Holter (ambulatory ECG) – to track the heart rhythm over time
- Echocardiogram – to evaluate heart structure and function
- Electrophysiology study (EPS) – in select cases, to map the rhythm source
Treatment Options for Atrial Flutter
Treatment depends on several factors including the duration, frequency, and underlying cause of the arrhythmia.
- Medications
- Rate control drugs e.g., beta-blockers, calcium channel blockers
- Antiarrhythmic medications to restore or maintain normal rhythm
- Preventing blood clots by using anticoagulants to reduce stroke risk-e.g. Warfarin, Apixaban, Rivaroxaban, and Edoxaban
- Electrical Cardioversion
Cardioversion is a short, controlled electrical shock delivered to the heart, used to reset a normal heart rate and regular (sinus) rhythm. Cardioversion may be recommended when an immediate restoration of normal heart rhythm is needed. This procedure is typically done under a short general anaesthetic to ensure comfort. Once asleep, an electrical shock is delivered to the heart through patches placed on the chest. The shock stops the heart’s beat momentarily before normal rhythm, also known as sinus rhythm starts again. However, this is unlikely to provide a permanent cure to flutter as the circuit continues to exist and it is a likely (>50%) chance that the flutter may recur at some stage.
- Catheter Ablation
This procedure is the treatment of choice for atrial flutter, providing a success rate of over 95%. It is minimally invasive procedure via keyhole surgery, using the radiofrequency energy to destroy the small area of heart tissue causing the abnormal rhythm. Catheter ablation is often considered a curative treatment for atrial flutter.
Managing Long-Term Health
Along with medical treatments, lifestyle changes can help reduce episodes and improve heart health:
- Manage high blood pressure and other conditions
- Avoid excess alcohol and caffeine
- Quit smoking
- Treat sleep apnea if present
- Maintain a heart-healthy diet and exercise plan
When to See a Cardiologist
Get in touch if you are experiencing:
- Fast or irregular heartbeats
- Chest pain or pressure
- Dizziness or fainting
- Shortness of breath
Atrial flutter is treatable, and in many cases, curable with the right approach. Early diagnosis and expert cardiology care and treatment can make a significant difference in your health and quality of life.
When Atrial Flutter Becomes a Concern
In some cases, atrial flutter may not cause noticeable symptoms, especially in individuals without other health problems. However, if you have existing conditions such as heart failure or advanced lung disease (like COPD), atrial flutter can rapidly worsen your breathing and overall health. If you experience sudden changes in your breathing or well-being, seek medical help immediately. One of the most serious concerns with atrial flutter is its potential to increase the risk of stroke, which is why timely diagnosis and treatment are essential.
Stroke Risk and Blood Thinners
If you have atrial flutter and one or more risk factors for stroke, your doctor will likely recommend anticoagulant medication to reduce the risk of blood clots. Commonly prescribed options include:
- Apixaban
- Rivaroxaban
- Dabigatran
- Edoxaban
Stroke risk factors include:
- Age over 65
- History of stroke or transient ischemic attack (TIA)
- High blood pressure
- Diabetes
- Previous heart attack or peripheral artery disease
- Heart failure
Expert Diagnosis and Treatment
Atrial flutter is a manageable condition, and with expert care, many patients can achieve long-term rhythm control and symptom relief. One of the most effective treatments is catheter ablation, a minimally invasive procedure that can offer a very high success rate, often over 95%, in eliminating the arrhythmia.