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Atrial Flutter

How does a normal heart beat?

The heart is a hollow muscular organ – approximately the size of your clenched fist – that beats 40 million times per year (between 60 and 100 beats per minute). The heart's pumping action is controlled by its electrical system, which gives rise to the heart rhythm.

Normal cardiac rhythm results from electrical impulses that begin in a special group of cells that form the sinoatrial (SA) node, also called the sinus node. Located in the right upper chamber of the heart, sinus node cells act as the heart's natural pacemaker. Impulses spread from the sinus node to the right and left atria (the upper chambers of the heart), causing them to contract at the same time. The impulses then travel to the AV (atrioventricular) node, the region that manages impulse traffic from the atria to the ventricles (the lower chambers of the heart). Here, impulses are slowed slightly to give the atria time to contract before the signal reaches the ventricles.

From the AV node, the impulses travel through a system of specialized heart tissue. Located in the wall that separates the two ventricles, this conducting system splits to form the right and left bundle branches that travel to the respective ventricles. Via this conducting pathway, powerful electrical 'jump-start' signals are delivered to the ventricular muscle of the heart. In the healthy heart, these impulses travel at the same speed so that the two ventricles contract at the same time, and oxygen-rich blood from the lungs is pumped throughout the body.

What is atrial flutter?

Atrial flutter is a rapid heart rhythm in which electrical signals in the atria are abnormally fast. In atrial flutter the upper chambers beat rapidly but regularly.

In atrial flutter, electrical impulses get "caught" in a single large circuit and travel in an endless loop around the atrium. The right atrium is particularly susceptible to this type of "reentrant" electrical conduction. This common arrhythmia usually occurs in older patients and patients with previous heart disease, although atrial flutter can even occur in younger patients and those with no structural heart disease. Patients with atrial flutter may also have atrial fibrillation.

What are the symptoms of atrial flutter?

Some patients do not feel atrial flutter; others find the symptoms disabling. Typical signs and symptoms include weakness – especially with exercise – rapid or pounding heartbeat (palpitations), dizziness, or shortness of breath.

What are the causes of atrial flutter?

Atrial flutter become more common as people age. These disorders are also associated with hypertension, valvular heart disease, or a history of coronary disease or heart attacks. They occur occasionally in young or middle age without any clear precipitating factors.

What risks are associated with atrial flutter?

Atrial flutter is not directly life threatening. The primary danger from this condition is stroke because this arrhythmia prevents the atria from pumping blood effectively. As a result, blood pools in the atria and may form small clots. If these clots reach the brain, they can cause a stroke. The risk of stroke can be minimized by treatment with blood "thinning" medication.

How is atrial flutter treated?

Several treatment options are available for atrial flutter, including:

  • Blood Thinners
    Blood clots and strokes are the most serious concern from atrial fibrillation and flutter. This danger can be largely prevented with proper blood "thinning" medications. Warfarin (also known as Coumadin) is a potent blood thinner. Proper dosing of this medication requires blood testing and monitoring by a physician. This medication is the treatment of choice for most patients with atrial fibrillation and risk factors for stroke. The degree of blood "thinning" is monitored by a blood test called an INR. An INR value between 2.0 and 3.0 is usually optimal for anticoagulation to be achieved.
  • Cardioversion
    Atrial flutter can usually be converted back to normal sinus rhythm. This may be done with medications or electrical current (called DC cardioversion). During electric cardioversion, an electrical impulse is delivered between two patches on the patient's chest. This resynchronizes electrical conduction in the atria and allows the sinus node to resume control. Electric cardioversion is highly effective and safe for restoring normal heart rhythm.
  • Medications to Maintain Normal Rhythm
    Your cardiologist may recommend medications to maintain the normal heart rhythm. These antiarrhythmic medications may be used after a cardioversion to prevent the recurrence of atrial flutter.
  • Catheter Ablation of Atrial Flutter
    Catheter ablation can cure atrial flutter. In this procedure, a catheter is inserted into a vein in the leg and is advanced to the heart. In the heart, energy is applied throught the catheter to destroy the abnormal electrical pathway that is causing the arrhythmia. The most commonly used energy source for treating atrial flutter is radiofrequency current. This procedure is extremely effective for eliminating atrial flutter.

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