Atrial Flutter: The Basics

WHAT IS ATRIAL FLUTTER?

 Atrial flutter is another form of arrhythmia that occurs when the heartbeat is too fast. It happens when the upper chambers of the heart beat too fast. The heart rhythm becomes asynchronous when the upper chambers of the heart (atria) do not beat in synchrony with the lower chambers (ventricles).

Atrial flutter is similar to atrial fibrillation and is sometimes mistaken for AF.

SYMPTOMS OF ATRIAL FLUTTER

A person with atrial flutter does not experience heart flutters as a symptom. The symptoms manifest in various other ways including:

• Fast heart rate
• Shortness of breath
• Lightheadedness
• Fainting
• Dizziness
• Heart palpitations
• Inability to carry out daily activities because of fatigue

Stress causes an increase in the heart rate and can further worsen the symptoms of atrial flutter. The symptoms seen in this condition are mostly general symptoms that can also be seen in other conditions thus experiencing one of these symptoms does not mean you have an atrial flutter. Symptoms can last for days or even as much as weeks, at a time. 

CAUSES OF ATRIAL FLUTTER

The heart rate is controlled by a natural pacemaker, the sinoatrial node. It is situated in the right atrium but it gives electrical signals to both the right and the left atrium. The signals given notify the atria about how and when to contract.

In atrial flutter, the sinoatrial node sends out electrical signals but some of the signals move as a continuous loop along a pathway surrounding the right atrium. This causes a rapid contraction of the right atrium, thereby making the atria to beat faster than the ventricles.

Normal heart rate ranges from 60 to 100 beats per minute (bpm) but those with atrial flutter have a heart rate in the range of 250 to 300 bpm. 

The causes of atrial flutter include:

Coronary artery disease

This is a major cause of atrial flutter. This disease occurs when the heart arteries get blocked due to the accumulation of plaque.

Plaque is caused by cholesterol and other fats that adhere to the walls of the artery. This causes a narrowing of the artery and slows down or stops blood flow. It can cause damage in the heart compartments, heart muscle, and blood vessels.    

Open-heart surgery

Open-Heart surgery can cause scarring of the heart. The scars will block electrical signals and this leads to atrial flutter.

RISK FACTORS FOR ATRIAL FLUTTER

The chances of developing this condition are more in people who take certain medications, the lifestyle choices and preexisting conditions. The following conditions are common in people who have atrial flutter:

• Smoking
• Heart disease
• Heart attack
• High blood pressure
• Heart valve conditions
• Lung disease
• Stress or anxiety
• Take diet pills or similar medications
• Excessive alcohol consumption or binge drinking
• Recent surgery
• Diabetes

DIAGNOSIS OF ATRIAL FLUTER

A suspicion of atrial flutter is made when the heart rate exceeds 100 bpm. A family history also helps in the diagnosis as a history of heart disease, anxiety, and hypertension can increase the risk.

Flutter can be diagnosed by a primary care doctor but you may need to be referred to a specialist for further testing.

The different tests that are used to diagnose and confirm atrial flutter include:

• Echocardiograms: they make use of ultrasound to create images of the heart. They are also good for measuring blood flow through the heart and blood vessels.
• Electrocardiograms: this measure and record the electrical activities of the heart.
• Electrophysiology (EP) studies: are used to record the heart rhythm, though are more invasive. A catheter is threaded from the femoral arteries in the groin into the heart. Electrodes are then passed to monitor heart rhythm in certain areas.

TREATMENT OF ATRIAL FLUTTER

The goal of treatment is to restore the heart’s rhythm to normal. Treatment depends on the severity of the condition. Other co-morbidities can affect the response to treatment and the kind of treatment given.

Medications

They are given to either slow down or regulate the heart rate. Some medications may warrant hospitalization so that their levels can be monitored while your body adjusts. Such medications include calcium channel blockers, beta-blockers, and digoxin.

Some other drugs are useful for converting atrial flutter rhythm back to normal sinus rhythm. Examples of these are amiodarone, propafenone, and flecainide.

To prevent any clot from forming in the arteries, blood thinners can be used and they include non-vitamin K oral anticoagulants (NOACs). Clots can lead to a stroke or even a heart attack when they dislodge. Those with atrial flutter have a very high risk of blood clots.

NOACs are the preferred anti-coagulants because they do not require frequent blood tests for monitoring and they do not have any recognized food interactions. This is in contrast to the conventional anticoagulant, warfarin.

Surgery

When medications are not enough to control atrial flutter, surgery is used and the type of surgery done is the ablation therapy. In this therapy, the tissues of the heart causing the abnormal rhythm are destroyed. A pacemaker may be needed following surgery to control the heartbeat. A pacemaker can also be used even without an ablation being done.

Alternative therapies

Cardioversion or defibrillation can be used to shock the heart rhythm back to normal. The shock is induced by patches that are applied to the chest.

LONG-TERM OUTCOME

Most of the time, medications will effectively treat atrial flutter. However, there is a high risk of recurrence after treatment, depending on the cause of the condition. The risk of recurrence can be reduced by stress reduction and being compliant with the medications as prescribed.

This condition can be prevented by ensuring that you do not develop the medical conditions that increase its risk. Try to maintain a healthy lifestyle with a well-balanced diet and regular exercise, do not take excessive alcohol and cease smoking.