Atrial Flutter

What is Atrial Flutter?

Atrial flutter is a regular and very fast heart arrhythmia that originates in the upper chambers of the heart (atria). An electrical cycle occurs in the atria that increases the atrial rate to 200-300 per minute. The efficient functioning of the atria is impaired. Usually one of the 2 or 3 electrical loops is transmitted to the ventricle. It is this conduction ratio that determines the pulse rate.

What are the Differences Between Atrial Fibrillation and Flutter?

Atrial fibrillation (AFib) and atrial flutter are two different types of arrhythmia that originate in the atria, the upper chambers of the heart. Both are atrial arrhythmias, but there are important differences between them.

Electrical Activity: In Atrial Fibrillation, the atria vibrate in an irregular and uncoordinated manner, while Atrial Flutter is more regular. This is because there is a more stable electrical cycle in atrial flutter. In both, there is a risk of clot formation because the blood flow rate in the atria slows down.

They are easily distinguished from each other by their appearance on the ECG. Treatments include medication, shock therapy called cardioversion and ablation. However, ablation approaches are different from each other.

I have prepared a video for you to understand the difference between atrial fibrillation and flutter. I recommend you to watch it.

What are the Symptoms of Atrial Flutter?

Atrial flutter can cause palpitations, feeling tired, dizzy, fainting or feeling like you are going to faint.

What are the Risks of Atrial Flutter?

In atrial flutter, the effective contraction of the atria is impaired, which slows the flow of blood through the atria. Slow blood flow can cause clots to form inside the heart. If these clots break away from their location and enter the bloodstream, they cause problems with nutrition and oxygenation where they are dragged. If the clot travels to the brain it can cause stroke, if it travels to the intestinal vessels it can cause severe abdominal pain and death of intestinal tissue, if it travels to the leg veins it can cause nutritional problems in the leg.

Another important risk of atrial flutter is an excessive increase in heart ventricular rate. When the heart is constantly working at high speed, it gets tired and starts to grow and expand. This process can lead to heart failure. Therefore, it must be stopped.

Causes of Atrial Flutter?

Atrial flutter is more common in people with structural heart disease, but not necessarily. Atrial flutter can occur even if you have no known heart disease. Heart surgery, heart failure, coronary artery disease, valvular heart disease, an overactive thyroid gland and various medications increase the risk of atrial flutter.

Atrial Flutter Treatment Algorithm?

Medications, a shock procedure called cardioversion, or electrophysiologic studies and ablation treatments can be used to treat atrial flutter.
Medications can be used to normalize atrial flutter and prevent its recurrence.

Shock therapy is used to normalize an episode of atrial flutter and has no effect on preventing recurrence.

With ablation therapy, the source of the flutter is found and the mechanism is understood. By burning the source, both the palpitations are terminated and the risk of recurrence is prevented in the long term.

How is Atrial Flutter Diagnosed?

Atrial flutter is diagnosed with portable ECG recorders called ECG, holter or event recorder.

Can you have both AFib and atrial flutter?

A patient with atrial flutter is also more likely to have atrial fibrillation. The reverse is also true, i.e. a patient with atrial fibrillation is also more likely to have atrial flutter. This should therefore be taken into account when planning treatment. Because the electrophysiology and ablation methods are different in atrial fibrillation and flutter. If both are present together, treating both in one patient reduces the risk of future recurrence.

Atrial flutter ECG sample
Atrial flutter ECG sample

Reference: Atrial Flutter

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Picture of Prof. Dr. Taylan Akgün
Prof. Dr. Taylan Akgün

He is a cardiologist specialised in the diagnosis and treatment of heart rhythm problems (ablation), pacemaker procedures.
He works in Istanbul province.

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