Atrial Flutter (AFL) is a type of abnormal heart rhythm or arrhythmia. It occurs when the upper chambers of your heart beat too fast due to short circuit. When the chambers in the top of your heart (atria) beat faster than the bottom ones, the heart can race very fast and cause symptoms and lead to blood clots which can lead to stroke.
Unlike atrial fibrillation which is completely chaotic, atrial flutter is due to a single abnormal short circuit within either atrium. The commonest type is located in the right atrium and is known as typical atrial flutter (and this is what Tony Blair had in 2004 and needed ablation treatment). In typical atrial flutter, electricity rotates rapidly in an anti-clockwise direction around the tricuspid valve, the valve between the right atrium and right ventricle. Other flutter circuits can occur in both the right and left atria.
As your heart ages and particularly if you have conditions like high blood pressure or heart valve disease, the atria stretch and increase in size. This leads to disruption of normal electrical conduction between cells making reentrant circuits more likely to happen. When you have Atrial Flutter, electricity travels in a continuous loop e.g. around the tricuspid valve in the right atrium. This makes the atria contract rapidly, usually about 300 beats/min and this often causes the heart to beat faster causing palpitations and breathlessness. Atrial flutter is also commonly seen after cardiac surgery or in people who drink alcohol to excess, but it can also occur in people with apparently normal hearts.
Atrial Flutter Fact: A normal heart rate is 60 to 100 beats per minute (bpm). People with AFL have hearts that can beat as fast as 250 beats per minute.
The risk factors for AFL include certain medications, existing conditions and lifestyle choices. People who are at risk of atrial flutter tend to:
If you experience the symptoms of palpitations and have a tendency for any of the above, speak to your doctor immediately to discuss your options moving forward.
Typically, a person with Atrial Flutter feels rapid fluttering of their heart, but symptoms can also manifest in other ways. Some of these include:
Stress also raises your heart rate, and can exacerbate symptoms of AFL. It is important to remember that the symptoms of AFL are common in many other conditions. Having one or more of these symptoms is not always a sign of AFL. Symptoms can last for for just seconds or days, or even weeks, at a time.
Your doctors will suspect AFL if your heartbeat goes above 100 bpm when resting. Your medical history is also an important factor when your doctor is trying to diagnose AFL. A history of heart disease, anxiety issues, and high blood pressure can all affect your risk. Atrial Flutter is diagnosed using a standard electrocardiogram (ECG), or by wearing a cardiac monitor. The different types of Atrial Flutter are diagnosed using an EP (electrophysiology) study.
With Atrial Flutter your doctor’s main goal is to restore your hearts normal rhythm. Treatment depends on how severe your condition is. Other underlying health problems can also affect how AFL is treated.
Medications can may be prescribed in order to slow or regulate your heart rate. Certain medications may require a brief hospital stay while your body adjusts. Examples of these medications include calcium channel blockers, beta-blockers and digoxin.
Catheter ablation therapy is recommended for almost everyone with atrial flutter even if symptoms can be controlled through medication. This is because it success rates for ablation of typical atrial flutter is very high – 90-95% and the risk of complications very low, typically <1%. Atypical flutters have marginally worse success rates and slightly higher complication rates. Ablation destroys the heart tissue to stop the reentrant circuit from rotating back on itself and means Atrial Flutter can be cured completely with ablation, although some people need to have ablation repeated to achieve this.
Atrial Flutter causes blood flow within the atria to decrease and blood can stagnate leading to clot formation. If clots break away from the heart then they can travel to the brain causing a stroke. It is therefore very important you are assessed for anticoagulant treatment if you are diagnosed with Atria Flutter. This assessment is performed by calculating your CHADS-VASc score and is the identical process for working out whether you benefit from anticoagulants if you have Atrial Fibrillation. In essence, if you have more than 1 risk for strokes, then you are likely to benefit from taking an anticoagulant when you have Atrial Flutter. However, unlike Atrial Fibrillation, if catheter ablation is performed and cures the atrial flutter, anticoagulants can often be stopped, whilst in AF, they need to be continued indefinitely regardless of the outcome of ablation.
If you have, or suspect you have, Atrial Flutter, it’s important you let your doctor know straight away. You may need to speak to a specialist about atrial flutter in order to fully understand the extent of your condition. For more information about atrial flutter see our page on AF and AFL or get in touch to arrange an appointment with Dr Segal.