Atrial flutter is a type of irregular heartbeat, or an arrhythmia. It causes your heart to beat too fast. Atrial flutter doesn't always have symptoms, but it can sometimes have serious consequences if left untreated.
What Happens in Atrial Flutter?
Your heart has its own electrical system. It sends out signals that control your heartbeat. As long as your heart beats normally, your heart will remain able to do its job properly: pump oxygen-rich blood to the rest of your body.
But sometimes those electrical signals go awry. That can cause your heart to beat too fast, too slow, or erratically.
Atrial flutter is an arrhythmia that results from an abnormal electrical circuit inside one of your heart’s two upper chambers, or atria. Most often, this faulty signal develops in the right atrium. It causes both of your atria to beat extra fast, about 250-350 beats per minute. That, in turn, causes your heart’s two lower chambers, or ventricles, to pick up the pace as well. They can beat more than 150 times per minute during atrial flutter. By contrast, a normal heartbeat is 60-100 beats per minute.
An abnormally fast heart rate is called tachycardia. Because atrial flutter comes from the atria, it is called a supraventricular (meaning above the ventricles) tachycardia.
Types of Atrial Flutter
There are two main types of atrial flutter:
Typical. This is the most common type. It causes abnormal electrical signals that travel in a counterclockwise circle in your right atrium. It involves your heart’s tricuspid valve, which opens and closes with each heartbeat in order to control the flow of blood between your right atrium and your right ventricle. Less often, the signals travel in a clockwise direction. This is called reverse typical atrial flutter. In rare occurrences, the signals can travel in both directions.
Atypical. This rarer type of atrial flutter doesn't involve the tricuspid valve, and it can occur in either your right atrium or your left atrium. It can develop after you’ve had surgery or other procedures on your heart.
Atrial flutter can come and go. Your doctor might refer to this as paroxysmal atrial flutter. If yours continues for days or even weeks at a time, it’s considered persistent atrial flutter.
Risk Factors for Atrial Flutter
The following raise your risk of atrial flutter:
- Heart failure
- Previous heart attack
- High blood pressure
- Heart valve problems
- Heart surgery
- Congenital heart conditions
- Lung disease
- Untreated sleep apnea, which may cause the dilation, or enlargement, of your heart’s chambers
- Thyroid disease
- A history of alcohol abuse
- Chronic stress or anxiety
- A history of smoking
- Certain medications, such as some cold medicines or diet pills
- Misuse of stimulant drugs
- Family history of atrial flutter
- Older age
- Overexercising, such as that done by endurance athletes
Atrial Flutter Causes
Doctors don’t always know what causes atrial flutter. In some people, no root cause is ever found. But atrial flutter can result from damage to the heart caused by a variety of conditions.
Heart conditions that can cause atrial flutter include:
- High blood pressure (hypertension)
- Coronary artery disease
- Heart valve disorders
- Congenital heart defects (these are defects you are born with)
- Heart surgery
Other causes of atrial flutter include:
Atrial Flutter vs. Atrial Fibrillation
Atrial flutter is similar to another, much more common arrhythmia called atrial fibrillation, or AFib. The two share many of the same symptoms, like dizziness and heart palpitations, in which you can feel your heart racing, pounding, or skipping beats. However, it’s possible with both that you will have no symptoms. About 40% of people who have atrial flutter also have atrial fibrillation. Let’s take a look at the differences and similarities.
Impact on your heart rhythm
In atrial flutter, electrical impulses don’t follow their normal pathway through your heart. Instead, they travel in a loop around your heart’s upper chambers. That makes your heart beat too fast. But it doesn’t beat erratically. Despite the speed at which your heart beats, your heart’s rhythm remains steady. When your heart’s in an episode of atrial flutter, it can’t pump an adequate amount of blood to the rest of your body.
In AFib, on the other hand, the electrical signals that travel through the atria are fast and disorderly, causing your heart to beat too fast and in a chaotic rhythm. The result: your atria quiver -- or fibrillate -- instead of squeezing strongly. This prevents blood from flowing normally through your heart.
Atrial Flutter Symptoms
Some people with atrial flutter have no symptoms. Others describe:
- Palpitations (rapid heartbeat or a pounding or fluttering sensation in the chest)
- Shortness of breath
- Trouble exercising or with other physical activity
- Tiredness or lack of energy
People with heart or lung disease who have atrial flutter may have these and other, more significant symptoms:
- Angina pectoris (chest or heart pains)
- Feeling faint or lightheaded
When to Seek Medical Care for Atrial Flutter
Call your doctor:
- If you have any of the symptoms of atrial flutter
- If you’re taking medication for atrial flutter and you have any of the signs and symptoms described
If you've been diagnosed and are being treated for atrial flutter, go immediately to a hospital emergency room if you:
Atrial Flutter Diagnosis
If your doctor thinks you have atrial flutter based on your symptoms, you’ll undergo tests to confirm that as well as rule out other arrhythmias, such as atrial fibrillation.
These tests can tell a lot about what’s happening with your heart:
Electrocardiogram (EKG or ECG). In this quick, painless, noninvasive test, electrodes are attached to your chest, arms, and legs in order to measure and record your heart’s electrical activity. If you are in an episode of atrial flutter, your EKG reading will show that.
Holter monitor. Atrial flutter can come and go. If you weren't having an episode during your EKG, that test will not pick up abnormalities. In that case, you may be asked to wear a Holter monitor. This device is like a portable EKG. You wear it for a day or two, and it records your heart’s activity during that time. If you go into atrial flutter, the Holter monitor will pick that up.
Event monitor (sometimes called a cardiac event monitor). If your heart rhythm needs to be tracked for longer than 48 hours, this is what you’ll need. Like a Holter monitor, it’s a type of portable EKG. But it doesn't record continuously. Instead, it switches on when it detects an arrhythmia or when you manually activate it when you experience symptoms. These monitors can be worn for up to a month. Other types of monitors are available to track your heart rhythm over longer periods.
Echocardiogram. This painless and noninvasive test uses sound waves to create a picture of your heart at work. This will reveal any abnormalities, such as damaged heart valves or enlarged chambers, that affect how the heart pumps blood. It also can detect blood clots that can form due to atrial flutter. If your doctor needs a fuller view of your heart, you will be sedated before undergoing an echo test in which a probe gets inserted down your throat until it’s near your heart. Once there, it produces ultrasound images of your heart. It’s used to confirm that blood clots have not formed in your heart.
EP study. Short for electrophysiology study, this is an invasive test used to identify the cause of your atrial flutter. Your doctor will insert long, thin tubes called catheters into a blood vessel and move them to your heart. These catheters are tipped with sensors that can measure and record your heart’s electrical activity in great detail. The sensors also can send electrical signals that will speed up or slow down your heart, allowing your doctor to pinpoint any abnormal electrical signals that are causing your atrial flutter and where those signals are coming from. Sometimes, it’s possible to treat atrial flutter during this test.
Lung function tests. Atrial flutter sometimes occurs in people who have lung disease. Chronic obstructive pulmonary disease (COPD) is a risk factor for atrial flutter. Your doctor may order a series of tests to determine how well your lungs work. These could provide clues regarding your atrial flutter. These tests include:
- Spirometry, which measures how much air your lungs can hold and how much force you can exert when you breathe out to empty your lungs.
- Lung volume, which measures the volume of air in your lungs, including the amount of air that remains in your lungs after you breathe out.
- Diffusing capacity, which measures how easily oxygen enters your bloodstream.
- Exercise testing, which helps determine why you might have shortness of breath.
Blood tests. Your doctor will order blood tests to determine if you have an overactive thyroid, which can cause atrial flutter.
Atrial Flutter Treatment
Goals of atrial flutter treatment
Treatment has three main goals:
- Slow your heart rate. This is usually the first step in treatment. Your doctor will prescribe medications that slow the beating of your heart’s two lower chambers, or ventricles. This will allow your heart to pump blood more efficiently.
- Restore your heart’s normal rhythm. If your heart is in an episode of atrial flutter that does not correct itself, medications or procedures are available to bring your heart rhythm back to normal.
- Prevent blood clots. In atrial flutter, your heart can’t pump blood efficiently. This allows blood to pool in your heart. When blood does not keep moving as it should, blood clots may form in your atria. These clots can then get into your bloodstream and travel to your brain, causing a stroke. Clots also may form when your heart rhythm gets restored to normal. Medications can help reduce your risk of stroke.
Atrial flutter medications
Different types of medications may be prescribed for atrial flutter.
Drugs to slow your heart rate:
- Calcium channel blockers
- Digoxin (Lanoxin), which is for people who also have heart failure
Drugs to restore a normal heart rhythm:
- Amiodarone (Cordarone, Nexterone, Pacerone)
- Dofetilide (Tikosyn)
- Flecainide (Tambocor)
- Propafenone (Rythmol)
- Sotalol (Betapace, Sorine, Sotylize)
These treatments are sometimes called chemical cardioversion. They can restore a normal rhythm, but they can have significant side effects and are less effective than a cardioversion procedure. Only about 50% to 60% of people who take them will respond.
Drugs to prevent blood clots:
- Apixaban (Eliquis)
- Dabigatran (Pradaxa)
- Enoxaparin (Lovenox)
- Rivaroxaban (Xarelto)
- Warfarin (Coumadin, Jantoven)
Procedures That Treat Atrial Flutter
Cardioversion. Doctors use electrical shocks to convert your heart from atrial flutter to a normal rhythm. This is effective for about 75% to 90% of people.
Catheter ablation. In this procedure, a thin, flexible tube called a catheter is inserted into a blood vessel and moved to your heart. Once there, your doctor will use the catheter to deliver hot or cold energy to make scars in the part of your heart where your atrial flutter occurs. These scars block the abnormal electrical signals that cause atrial flutter so that your heart can beat normally. Ablation is the only treatment that can cure atrial flutter or significantly reduce the number of episodes you have.
If you have an implantable cardioverter defibrillator (ICD) or a pacemaker, your doctor may adjust the settings temporarily as part of your treatment.
Living With Atrial Flutter
An irregular heart rhythm can affect how well you can work, exercise, and do other activities. To manage it, follow the treatment plan your doctor prescribes. Medicines and other therapies can help control symptoms, like shortness of breath and palpitations, and lower your odds of having a stroke or heart failure.
It’s also important to eat right. Your doctor or a dietitian can help you plan a healthy diet. If you have a higher weight, losing some pounds may help you control symptoms.
Exercise can also help you manage your heart rhythm. Ask your doctor what types of activities are safe for you and how to get started in a new program.
Atrial Flutter Complications
Atrial flutter prevents your heart from pumping blood as well as it should. When blood flow slows, clots are more likely to form. If one travels to your brain, it can cause a stroke. Blood clots also can block blood flow to your heart, causing a heart attack.
A fast heartbeat also lowers your blood pressure and weakens your heart muscle over time. This can lead to heart failure -- when your heart can't pump out enough blood to supply your body.
Atrial Flutter Prevention
You can reduce your chances of developing atrial flutter. Your primary focus should be on limiting or eliminating the factors that put you at risk. Try to:
- Maintain a healthy weight
- Drink alcohol in moderation or avoid it altogether
- Quit smoking
It's critical to manage medical conditions that can lead to atrial flutter too. These conditions include:
- High blood pressure (hypertension)
- Heart valve disorders
- Birth defects in your heart
- Coronary artery disease
- Obstructive sleep apnea
- Overactive thyroid
If you have atrial flutter, healthy lifestyle changes can help reduce the episodes you experience. Here’s what you can do:
- Eat a heart-healthy diet.
- Exercise, such as taking a daily 30-minute walk.
- Avoid stimulants, including caffeine, some over-the-counter cold and diet medications, and some herbal supplements. Ask your doctor or pharmacist for guidance.
- Manage stress with breathing exercises, yoga, and/or talk therapy.
Atrial flutter is an abnormal heart rhythm, or arrhythmia, that causes your heart to beat too fast. Some people don’t have symptoms or require treatment, but atrial flutter can cause serious, even life-threatening complications. If you suspect that you have atrial flutter, talk to your doctor. It is a highly treatable condition.
Atrial Flutter FAQs
How serious is atrial flutter?
Atrial flutter raises your risk of stroke, so it can be life-threatening.
What is the best treatment for atrial flutter?
Your doctor will determine the most appropriate medications and other treatments for you. You may require more than one type of medication or procedure. Some people will need to take medications for atrial flutter for the rest of their lives.
Is a flutter worse than Afib?
Afib is more common and creates a more chaotic heartbeat than atrial flutter. However, both raise your risk of stroke and require medical attention.
Can you live a long life with atrial flutter?
Yes. With treatment, atrial flutter can be managed and sometimes cured. However, if you don’t get treated, you run the risk of stroke and other serious complications.