Arrhythmias
Atrial flutter
Atrial flutter is a heart rhythm problem that affects the upper chambers of the heart, known as the atria. Instead of beating at a normal pace, the atria beat rapidly, but in a regular and organised pattern rather than a chaotic one. Because the chambers do not have enough time to fill properly, blood is not pumped efficiently from the top chambers to the bottom chambers, which is what leads to shortness of breath.
What atrial flutter is and what happens in the heart
Atrial flutter is a condition that affects the upper chambers of the heart, the atria. These chambers primarily receive blood into the heart before it is pumped by the lower chambers, the ventricles, to either the lungs or the rest of the body.
Arrhythmias are heart rhythm or conduction issues in which the electrical conduction of the heart is affected. In atrial flutter, that disruption produces a regular but rapid beat in the atria rather than an irregular, chaotic impulse. The impulses during a flutter may be 4 to 5 times faster than those of the ventricles.
Because the atria are firing so quickly, blood is not efficiently pumped from the top chambers to the bottom chambers, as there is not enough time for the chambers to fill. That is what leads to shortness of breath.
How atrial flutter differs from atrial fibrillation
Atrial flutter and atrial fibrillation both affect the upper chambers of the heart, and the two are often discussed together, but the electrical behaviour is not the same.
In atrial fibrillation, commonly known as AF, the atria fire chaotic electrical impulses, which leads the muscle to quiver, or fibrillate, instead of beat. Atrial flutter, by contrast, is a rapid beat that stays regular and organised.
Treatment for the two conditions overlaps. Both begin with medication to control the heart rate and regulate heart function, and both may be treated with DC cardioversion or with ablation procedures.
There are differences as well. Patients diagnosed with AF may often also be commenced on blood thinning medication to prevent the risks of stroke or other blood clot formations in the heart. Whether blood thinning medication is appropriate for any individual patient is a decision made case by case, so it is worth asking Dr Jogiya what your own diagnosis means for you.
The symptoms people notice
Atrial arrhythmias, the group of rhythm problems that atrial flutter belongs to, can cause a wide range of symptoms, and they vary from one person to another.
Symptoms you may notice include the following.
- Shortness of breath, which happens because the chambers do not have enough time to fill and blood is not pumped efficiently
- Palpitations, which people describe in different ways, such as a rapid pounding in the chest, a fluttering sensation, or the impression that the heart has skipped a beat
- Dizziness or light-headedness
How atrial flutter is diagnosed
The diagnosis of heart rhythm issues is usually done through an ECG, or a Holter monitor, which is a prolonged ECG recording, to get an understanding of the heart rhythm.
An electrocardiogram measures the electrical signals of the heart and shows what the rhythm is doing at the moment it is recorded. One of the practical challenges is that an episode may not happen during a short clinic visit, so if symptoms come and go, Dr Jogiya may recommend longer monitoring with a portable device worn for 24 hours or longer.
Additional tests such as echocardiography may also be used to examine the structure and function of the heart.
Once treatment has started, regular ECGs will be conducted to ensure that treatments are successful and effective.
How atrial flutter is treated
Effective treatment for atrial flutter begins with medication to control the heart rate and regulate heart function.
Other treatments can be used to try to reset the heart to its natural rhythm.
The most appropriate plan depends on factors such as age, overall health, symptoms, and other medical conditions, which is why Dr Jogiya will discuss the options with you rather than applying a single approach to everyone.
- Medication to control the heart rate and support the way the heart functions
- DC cardioversion, a procedure used to try to reset the heart to its natural rhythm
- Ablation procedures, which target the areas of heart tissue responsible for triggering the abnormal electrical signals
When to seek help
Call 999 straight away if you develop sudden or severe chest pain, if you collapse or lose consciousness, or if you or someone with you develops sudden signs of a stroke, such as the face dropping on one side, weakness in one arm, or slurred speech. A stroke is a serious, life-threatening condition that requires immediate and urgent treatment to minimise the damage to the brain.
Outside an emergency, it is always reasonable to seek advice if you are unsure about your symptoms. An assessment is worth arranging if palpitations are frequent or getting worse, if they occur alongside dizziness or breathlessness, if they happen during physical exertion, if they last for prolonged periods, or if the episodes feel different from anything you have experienced before.
Dr Jogiya is an expert in arrhythmia treatment and the management of abnormal heart rhythms. An assessment usually begins with a detailed history of your symptoms, followed by a recording of the heart rhythm, so that the right treatment can be matched to what is actually happening in your heart.
This page is general information about atrial flutter and is not individual medical advice.
More in arrhythmias
Related conditions he treats.
- Atrial fibrillationAtrial fibrillation, commonly known as AF, is a condition where the atria, or upper chambers of the heart, fire chaotic electrical impulses. This leads the muscle to quiver, or fibrillate, instead of beat, so the heartbeat becomes irregular and is often faster than normal. It is one of the most common heart rhythm issues and around 1.7 million people in the UK have been diagnosed with it.
- Atrial tachycardiaAtrial tachycardia is a fast heart rhythm that starts in the atria, the two upper chambers of the heart. An electrical signal emerges from another section of the atria and causes a rapid repeating beat, which means the atria beat very fast. It is one form of supraventricular tachycardia, or SVT, and short bouts of it can be common.
- Bundle branch blockBundle branch block describes a block in the part of the heart's conduction system known as the bundle branches. These branches carry the electrical impulse from the AV node down to each ventricle, and when one of them is blocked the signal reaches one side of the heart before the other, so the two ventricles no longer contract in step. It is a pattern picked up on an ECG, and mostly it is something monitored rather than actively treated.
- First degree heart blockFirst degree heart block is common, and it can affect anyone at any age. It describes a delay in the electrical signal as it travels from the upper chambers of the heart to the lower chambers, rather than a true blockage. Every signal still gets through, which is why many people notice nothing at all and why the condition is usually diagnosed when testing is being done for something else.
- Second degree heart blockSecond degree heart block is a fault in the heart's electrical wiring, not a blockage in an artery. Some of the electrical signals travelling from the upper chambers of the heart fail to reach the lower chambers, so a heartbeat is occasionally missed. There are two types, known as Mobitz I and Mobitz II, and they are treated very differently.
- Sick sinus syndromeSick sinus syndrome, also called sinus node disease, is a condition where the sinus node, the small area of tissue that acts as the heart's own natural pacemaker, is not functioning properly. Sometimes the node will send an impulse as it should, and sometimes it may not fire an impulse at all, or the impulses may be out of sync. Some patients notice symptoms such as palpitations and shortness of breath, and because the node is unreliable rather than permanently stopped, those symptoms often come and go.
- Supraventricular tachycardiaSupraventricular tachycardia, usually shortened to SVT, is a fast heart rhythm that starts above the ventricles, in the upper part of the heart. Symptoms vary widely from one person to another, so some people are very aware of an episode while others barely notice one. Short bouts of SVT can be common, and can usually be treated very easily.
- Tachy brady syndromeTachy brady syndrome is a heart rhythm problem in which the heart rate increases and then decreases spontaneously, without any external influence. Instead of settling at a pace that matches what you are doing, the heart swings between periods of a slow rate and sudden bursts of a fast one. It is closely linked to sinus node disease, and it occurs mostly alongside atrial fibrillation.