Atrial Flutter

What is atrial flutter?

Atrial flutter is a type of heart rhythm problem (arrhythmia). Your heart is made up of two key ‘zones’: the upper chambers (atria) pump blood into the lower chambers (ventricles), and the pumping is controlled by electrical impulses from the brain. In atrial flutter, the impulses become disrupted, causing the atria to beat much faster than normal – sometimes as much as 300 times per minute (where a normal heart beats around 60-100 times per minute). Since the ventricles aren’t able to pump as quickly as the atria, the two chambers begin to beat at different speeds. This can put the heart under strain.

Is atrial flutter the same thing as atrial fibrillation?

No. Atrial Fibrillation (AF) is another type of arrhythmia. The two conditions are similar in that they both originate in the upper chambers, can cause an increase in the heart rate, and often occur in the same patients – around 30% of people with atrial flutter also suffer from AF. The main difference is that a heart with atrial flutter may beat regularly (albeit very quickly), whereas with AF the beat tends to be irregular / less organised. A ‘typical’ or common type of Atrial flutter usually originates in the right atrium.

What causes atrial flutter?

Atrial flutter is essentially caused by abnormal electrical signals circulating in the upper chambers of the heart. What causes this to happen in the first place can be quite difficult to determine. It could be related to another underlying condition, such as:

• High blood pressure (hypertension)
• Heart failure (which essentially means the heart isn’t pumping strongly enough)
• Heart valve disease
• Previous heart attack (myocardial infarction)
• Lung disease (such as pneumonia or chronic bronchitis)
• Pulmonary embolism (a lung clot)
• Thyroid gland abnormalities

Excessive alcohol consumption is also known to increase the risk of atrial flutter. Sometimes the cause may be a combination of factors. In other cases, however, there may be no obvious cause. Although less common than AF, atrial flutter is still a relatively common condition: it’s thought to affect about one in every 1,000 people. It’s also more commonly seen in older people, and men are more than twice as likely to women to have the condition.

What does atrial flutter feel like?

As with AF, atrial flutter doesn’t necessarily cause symptoms. You could develop the condition without realising you have it until it’s picked up by a doctor during another medical check-up. Where symptoms do occur, people usually experience them as a palpitation, tiredness, shortness of breath and even dizziness. Less commonly, it can cause fainting or chest pains.

How do you diagnose atrial flutter?

The usual way to diagnose atrial flutter is with an electrocardiogram (ECG), a straightforward test that uses sensors on the skin to view your heart’s electrical impulses. Or we might ask you to take a Holter monitor home with you – this is a portable ECG that you can wear for 24 hours or more. We sometimes also use an electrophysiological study (EP) for diagnosis – this is a specialist test carried out in a clinic or hospital that looks in more detail at your heart’s activity.

What happens next?

Although atrial flutter isn’t life-threatening, the symptoms can be uncomfortable or distressing and it can put a strain on the heart. It can also increase the risk of a stroke, whether or not you experience symptoms. This is because, when blood isn’t flowing normally around the heart, it may begin to pool and form clots. The clots could then break away and flow into smaller blood vessels around the body, such as in the brain, where they can restrict or block blood flow (ischaemia).

Depending on your situation, there are several different ways to treat atrial flutter, and sometimes these methods are used in combination. When we review you in the clinic, we’ll determine which approaches would be best for you. These include:

Medication – medicines like beta blockers, calcium channel blockers or digoxin to control your heart rate and slow the speed of the pulse, or anti-coagulants and other anti-arrhythmic medicines.

Catheter ablation – a keyhole surgery procedure that uses high-frequency radiowaves to destroy the tiny area of tissue in the heart that is causing the electrical ‘short-circuiting’ effect.

Electrical cardioversion – a procedure that applies a carefully controlled electrical current to ‘reset’ the heart and restore its normal rhythm.