What Is Atrial Flutter?

Overview

Atrial flutter starts in the upper chambers of your heart (atria). It is when your upper chambers beat at a much quicker rate than usual, resulting in a faster heart rhythm. It is the second most common type of arrhythmia (irregular heart beat) after atrial fibrillation.¹ 

The presence of atrial flutter creates some problems, one of which is increasing your chances of developing a stroke.² Due to the upper chambers contracting at a faster rate than normal, the upper chamber does not fill up with enough blood before contracting and pumping it into your ventricles (lower chambers of your heart). The consequence of this is not enough blood being pumped around your body.¹

Types of atrial flutter:

There are 3 different types of atrial flutter. They are classed depending on the location of the origin of the irregular rhythm. Although symptoms of the three types are similar, treatment may slightly vary. 

Typical:

This is the most common type of atrial flutter. The abnormal electrical signals that cause the flutter starts in the right atrium and move in a counterclockwise direction.³ The abnormal electrical signals originate by the tricuspid valve in this type of flutter. 

Reverse typical:

Similar to the typical atrial flutter in that it originates in the right atrium. However, the circuit moves in a clockwise direction unlike the typical atrial flutter. 

Atypical:

This refers to any atrial flutter that does not circle around the tricuspid valve which is a feature of both the typical and reverse atrial flutter⁴. This type of atrial can start in either the left or right atrium. This flutter typically produces a faster rhythm compared to the typical flutter. It is not common unless you have had previous heart surgery or previous treatment to restore the regular rhythm of your heart known as ablation. 

Causes of atrial flutter:

Atrial flutter is typically seen in people with an underlying condition such as COPD, heart failure, pulmonary hypertension or people with heart defects^.1 It is not common to see atrial flutter in people without some abnormal heart anatomy or condition. 

Causes of atrial flutter include:

• Previous cardiac surgery
• Previous catheter ablations
• Heart valve disorders
• High blood pressure
• Coronary artery disease
• Overactive thyroid
• Heart conditions (could be present from birth)^2,3

Signs and symptoms of atrial flutter

Atrial flutter could either be asymptomatic or cause the following symptoms:

• Heart palpitations
• Shortness of breath, especially during exercise
• Fatigue
• Dizziness or fainting
• Lightheadedness
• Chest pain^1,3

Management and treatment for atrial flutter

There are various treatment options available to people with atrial flutter. These can vary from medications to medical procedures. Your healthcare professional will evaluate your symptoms and medical history and advise you on the most suitable treatment option for you. In some instances, an atrial flutter will resolve on its own without the need for any further intervention.

Treatment Options:

Treat underlying conditions: as an atrial flutter is typically a symptom of a medical condition, treating that condition consequently treats the atrial flutter.

Antiarrhythmics: medication that helps correct and control your heart rhythm.

Anticoagulants: medication that helps prevent blood clots.

Catheter Ablation: a medical procedure where the tissue that is causing the abnormal electrical signals is destroyed.

Cardioversion: a procedure where a small shock is provided to correct the rhythm.¹

Diagnosis of atrial flutter

Your doctor will likely carry out an ECG, to observe the electrical activity of your heart. If results are still unclear after that, you may be recommended to get a Holter monitor which will let the doctor know whether or not you have atrial flutter. 

Other diagnostic tests that may be carried out:

• Echocardiogram
• Blood tests
• Pulmonary lung function tests

Risk factors

Common risk factors that increase your likelihood of developing atrial fibrillation include:

• Age-atrial flutter is commonly seen in people older than 50 years and the risk increases with age
• Male
• Heart issues - e.g heart failure or a valve issue
• High blood pressure
• Lung disease
• Diabetes
• History of alcohol use disorder
• Obstructive sleep apnoea
• Obesity³

Complications

Atrial flutter can cause your heart muscle to weaken over time due to the fast pulse, this is known as cardiomyopathy⁵

The inefficient heartbeat can also cause blood to collect or pool which may result in the formation of a blood clot. The clot can break away and enter your bloodstream and cause a stroke or a heart attack. 

Your blood pressure could drop due to less blood being pumped around your body than usual which could lead to heart failure.

FAQs

How can I prevent atrial flutter?

There are certain things that can increase the likelihood of you developing an atrial flutter, some of which are unavoidable such as heart defects that were present at birth. One of the preventative measures that you could take to decrease your chances of getting an atrial flutter is to limit alcohol intake.

Other steps you can take to minimise the risk of you developing an atrial flutter is to seek medical attention to help manage any underlying conditions that could cause atrial flutter down the line, these include: ⁶

• Coronary artery disease
• Obesity
• Overactive thyroid
• High blood pressure
• Heart valve disorders
• Obstructive sleep apnoea
• Heart defect

How common is atrial flutter?

Although the precise incidence of atrial flutter is not well studied, the following gives an indication of how common it is:

• It is the second most common arrhythmia
• Males make up 80% of all atrial flutter cases
• It is more common in the older population and prevalence increases with age⁶

When should I see a doctor?

You should go to the ER if you have a heart rate of 150 bpm or greater at rest³

Summary

Atrial flutter is when your atria beats at a rhythm that is much faster than usual causing a rapid heart rhythm. This can cause several problems such as a stroke or heart failure. If you have atrial flutter you may experience fatigue, shortness of breath, heart palpitations or dizziness. Doctors can provide medication that prevents blood clots or corrects your heart rhythm. Alternatively, they can perform procedures such as catheter ablations or cardioversion that destroy the heart tissue that causes the abnormal rhythm or corrects it.