Atrial fibrillation and atrial flutter tend to coexist, with the significance of atrial flutter in the initiation and perpetuation of atrial fibrillation recently becoming more apparent. Long-lasting atrial flutter with continuously rapid ventricular rates (heart rates typically greater than 100 beats per minute) may cause a tachycardia-induced cardiomyopathy (weakening of ventricular muscle and heart function) and symptoms of congestive heart failure.
In addition, prolonged episodes can make reversion and maintenance of normal sinus rhythm more difficult. In addition to the risk of stroke, prolonged episodes of atrial flutter can cause irreversible changes to the atria, including negative remodeling with atrial enlargement and weakness (myopathy). The decision to implement long-term anticoagulation (that is blood thinners) must be individualized after a discussion between you and your treating physician. Some of these risk factors include age, presence of structural heart disease, hypertension, diabetes, history of stroke, valvular heart disease, heart failure, and coronary artery disease. Therefore, consultation with your physician is very important in determining the presence of additional risk factors for stroke that may require treatment with the blood thinner warfarin (also known as coumadin). The risk of stroke is not the same for all people with atrial flutter. This pooled blood is more likely to form clots that can travel to the systemic circulation and the brain, leading to a cerebrovascular accident or stroke. This is a direct results of the rapid atrialcontraction that leads to a stasis or pooling of blood in the atria particularly, the left atrium. However, similar to atrial fibrillation, atrial flutter poses an increased risk of stroke. PrognosisĪtrial flutter, with appropriate treatment, is rarely life-threatening. It appears to be 3:1, with every 3 atrial flutter waves associated with one ventricular beat. The ventricular response, or heart rate, is determined by the ratio of atrial beats that are conducted to the ventricles via the normal AV node.
EKG strip of atrial flutter with the “flutter waves” denoted by the red arrows. In these situations, your physician may recommend a special ambulatory monitoring device that is patient-triggered, i.e. Some episodes of atrial flutter are intermittent (also referred to as paroxysmal) and not reliably present on a daily basis. Holter or Event monitor, specifically during an arrhythmia episode. DiagnosisĪtrial flutter can be diagnosed by your physician via an electrocardiogram or an Ambulatory monitoring device, i.e. Patients with sustained rapid heartbeats should seek medical attention. Episodes of atrial flutter can last anywhere from minutes to days or months. However, some people with atrial flutter may not have any symptoms at all. Similar to other SVTs, patient may feel short of breath, fatigue, dizziness, or rarely, even fainting. SymptomsĮpisodes of atrial flutter can lead to rapid heartbeats with symptoms of palpitations and chest fluttering or tremoring. Ablation of this rhythm targets a critical portion of the circuit know as the cavotricuspid isthmus (CTI) it is to this area bounded by the tricuspid valve and the inferior vena cava (IVC) that a linear ablation lesion can be delivered with successful interruption and termination of the circuit. Animated illustration of the electrical circuit in the right atrium during typical atrial flutter. Conditions that lead to right-sided heart dilation and increased pressure can increase the incidence of this rhythm disturbance (right-sided heart failure, pulmonary hypertension, COPD, hypertension, obesity, tricuspid or pulmonary stenosis).įigure 1.
It can occur in patients with no structural heart disease (lone atrial flutter), but is more likely in those with a history of prior cardiac surgery, congestive heart failure, or congenital heart disease. The heartbeat on exam is typically fast, but with medications, it can be slow with either a regular or irregular pulse.Ītrial flutter is the result of a rapid electrical circuit localized to the top right heart chamber, the right atrium. This electrical circuit has been extensively mapped using electrophysiology-guided catheter mapping techniques. The atria can contract anywhere from 250-400 beats per minute, with the AV node serving as the “traffic control” preventing 1 to 1 conduction to the ventricles. Atrial flutter, another type of supraventricular tachycardia, produces a heart rhythm with typically more atrial contractions than ventricular beats.
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