The heart is comprised of four chambers: two upper chambers (atria) and two lower chambers (ventricles). Electrical signals regulate the heart beat, and help the atria and ventricles to work together in the same rhythm. The blood from the atria is pushed into the ventricles, and then leaves the heart to circulate to the rest of the body.

Atrial flutter is a type of abnormal fast beating (arrhythmia) in the upper chambers (atria) of the heart. These fast beats prevent the atria from pushing all the blood into the ventricles. In turn, this prevents the body from receiving enough blood.

Atrial flutter may be an acute or chronic recurring disorder. When treated, atrial flutter is not usually life-threatening. However, it may increase your risk of developing blood clots and stroke.

This condition can easily be treated; contact your doctor if you think you may have atrial flutter.

Causes

Atrial flutter may be caused by the following:

• Heart disease

• Heart surgery – atrial flutter is most common during the first few weeks after open-heart surgery

• Disease elsewhere in the body that affects the functioning of the heart

• Intake of substances such as caffeine, alcohol, diet pills, or certain types of prescription or over-the-counter medication that affect the electrical impulses of the heart

• Stress and anxiety

Risk Factors

The following factors increase your chances of developing atrial flutter. If you have any of these risk factors, tell your doctor:

• Heart disease

• Heart surgery

• History of high blood pressure (hypertension)

• Abnormalities of the heart or heart valves (e.g., hypertrophy, mitral valve prolapse)

• Overactive thyroid gland (hyperthyroidism)

• History of chronic lung disease (e.g., emphysema, chronic obstructive pulmonary disease)

• High levels of stress or anxiety

• Chronic use of caffeine, alcohol, diet pills, or certain types of prescription or over-the-counter medication (such as cold medicines)

Atrial flutter is more likely to develop in older adults.

Symptoms

If you experience any of these symptoms, do not assume the cause is due to atrial flutter. These symptoms may be caused by other, less serious health conditions. If you experience any one of them consistently, see your physician.

Atrial flutter does not always produce symptoms. However, symptoms, when present, include:

• A “fluttering” or tremor-like feeling in the chest

• Palpitations (rapid heart beat or pounding sensation in the chest)

• Pressure or discomfort in the chest

• Shortness of breath

• Anxiety

• Dizziness or fainting

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. Depending on your condition, your doctor may also recommend that you see a cardiologist or arrhythmia specialist. This type of physician may be found in a larger hospital.

Tests may include the following:

• Electrocardiogram (ECG, EKG) – A test that records the heart's activity by measuring electrical currents through the heart muscle.

• Holter Monitor – A device worn around the neck that will continuously record your heart rhythm for a 24-72 hours.

• Echocardiogram – A test that uses high-frequency sounds waves (ultrasound) to examine the size, shape, and motion of the heart.

• Electrophysiological or EP Study – A test in which catheters are threaded through arteries in your groin or neck all the way into your heart. This test may help identify the exact source of an abnormal rhythm. An area of the heart responsible for an abnormal rhythm may also be treated during the course of this study (see Ablative Therapy under the Treatment section).

Treatment

The goal of treating atrial flutter is to slow down the electrical impulses that are sent from the atria (upper chamber of the heart) to the ventricles (lower chamber of the heart), restore normal rhythm, and prevent future episodes. Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Pharmacologic (Medication) Therapy

Medication may be given to slow the rapid heart rate and convert the atrial flutter to a normal rhythm. These medications may include:

• Beta-blockers (e.g., metoprolol)

• Digoxin

• Adenosine

• Nonhydropyridine calcium channel antagonists (e.g, diltiazem, verapamil)

Cardioversion (Defibrillation)

An external defibrillator is applied to the chest, and uses electrical current to “shock” the heart back to its normal rhythm. This is the preferred treatment technique.

Ablation Therapy

When cardioversion is not sufficient, ablation can be instituted during the course of an EP study. Using the same catheters, an area of the heart from which an abnormal electrical rhythm is generated can be destroyed.

Blood Thinners

When atrial flutter is chronic, blood thinners are an important therapy to prevent blood clots that can cause strokes or other serious complications.

Prevention

To help reduce your chances of getting atrial flutter, take the following steps:

• Reduce or eliminate use of caffeine, stimulants, alcohol, nicotine, certain medications (e.g., cold medicine, diet pills) or recreational drugs

• Obtain treatment for any underlying heart or lung disease

• Reduce your levels of stress and anxiety

• Check with your doctor before taking any new medications, herbs, or supplements

RESOURCES:

American Heart Association
http://www.americanheart.org

American College of Cardiology
http://www.acc.org

National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov

CANADIAN RESOURCES:

Canadian Cardiovascular Society
http://www.ccs.ca

Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca

References:

Atrial flutter. Heart Rhythm Society website. Available at http://www.hrspatients.org/patients/heart%5Fdisorders/atrial_fibrillation/aflutter.asp. Accessed August 15, 2005.

Atrial flutter and treatment. American Heart Association website. Available at http://www.americanheart.org/presenter.jhtml?identifier=52. Accessed August 14, 2005.

Fauci AS, et al. Harrison’s Principles of Internal Medicine, 14th ed. New York, NY: McGraw-Hill; 1998.

Lee KW, Yang Y, Scheinman MM. Atrial flutter: a review of its history, mechanisms, clinical features, and current therapy. Curr Prob Cardiol. 2005;30(3):121-167.