Also called atrial flutter (AFL), it is an abnormal heart rhythm, similar to atrial fibrillation, the most common abnormal heart rhythm.
Both conditions are types of supraventricular tachycardia (above the ventricles).
In the AFL, the upper chambers (atria) of the heart beat too fast, which produces atrial muscle contractions that are faster than the lower chambers (ventricles) and are not synchronized with them.
The electrical system of the heart is the source of energy that makes the heart beat. The electrical impulses travel along a path in the heart and cause the upper and lower chambers of the heart (atria and ventricles) to work together to pump blood through the heart.
A normal heartbeat begins as a single electrical impulse that comes from the sinoatrial node (SA), a small bundle of tissue located in the right atrium. The impulse sends an electrical impulse that causes the atria to contract (tighten) and move the blood to the lower ventricles.
The electrical current passes through the atrioventricular (AV) nodule (the electrical bridge between the upper and lower chambers of the heart), causing the ventricles to be compressed and released in a stable rhythmic sequence.
As the cameras compress and release, they draw blood to the heart and push it to the rest of the body and lungs. This is what causes the pulse that we feel in our wrist or neck.
With atrial flutter, the electrical signal travels along a path inside the right atrium. It moves in an organized abnormal circular motion, or “circuit,” causing the atria to beat faster than the ventricles of your heart.
Flapping headphones a heart rhythm disorder that is similar to the more common AFib.
In AFib, the heart beats fast and does not have a regular pattern or rhythm. With atrial flutter, the heart beats abnormally fast , but in a regular pattern. The fast but regular pattern of fluttering headphones makes it special.
The atrial flutter performs a very distinctive “sawtooth” pattern on an electrocardiogram (ECG) , a test used to diagnose abnormal heart rhythms.
Risk factors for atrial flutter
Some medical conditions increase the risk of developing AFL. These medical conditions include:
- Heart failure.
- Previous heart attack
- Acquired or congenital valvular anomalies.
- High blood pressure
- Recent upper chamber surgery.
- Thyroid dysfunction.
- Alcoholism (especially drunkenness).
- Chronic lung disease.
- Acute (severe) disease.
The electrical signal that causes atrial flutter circulates in an organized and predictable pattern. This means that people with atrial flutter usually continue to have a constant heart rate, even though it is faster than normal.
It is possible that people with atrial flutter can not feel any symptoms. Others do experience symptoms, which may include:
- Heart palpitations (feeling like your heart is racing, throbbing or fluttering).
- Fast and constant pulse.
- Short of breath.
- Problems with daily activities or exercises.
- Pain, pressure, tightness or discomfort in the chest.
- Dizziness, lightheadedness, or fainting
The physical signs include the following:
- The heart rate is often approximately 150 beats / min due to AV block 2: 1.
- The pulse may be regular or slightly irregular.
- The hypotension is possible, but normal blood pressure is observed more frequently.
Other points to consider in the physical examination are the following:
- Palpate the neck and thyroid gland for goiter.
- Evaluate the neck for jugular venous distention.
- Auscultate the lungs for rales or crackles.
- Auscultate the heart for heart sounds and additional murmurs.
- Palpate the maximum impulse point on the wall of the chest.
- Evaluate the lower extremities to detect edema or altered perfusion.
Complications of atrial flutter
The atrial flutter itself is not life threatening. If left untreated, the side effects of atrial flutter can be life-threatening.
Atrial flutter makes it harder for the heart to pump blood effectively. With blood moving more slowly, clots are more likely to form.
If the clot is pumped out of the heart, it could travel to the brain and cause a stroke or heart attack.
Without treatment, atrial flutter can also cause a rapid pulse rate for long periods of time.
This means that the ventricles are beating too fast. When the ventricles beat too fast for long periods of time, the heart muscle may weaken and become tired. This condition is called cardiomyopathy . This can lead to heart failure and long-term disability.
Without treatment, atrial flutter can also cause another type of arrhythmia called atrial fibrillation. Atrial fibrillation (AFib) is the most common type of abnormal heart rhythm.
The following techniques help in the diagnosis of atrial flutter:
- Electrocardiography (ECG): this is an essential diagnostic modality for atrial flutter.
- Vagal maneuvers: they can be useful to determine the underlying atrial rhythm if the flutter waves do not look good.
- Stress test: can be used to identify atrial fibrillation induced by exercise and to evaluate the response of the ventricular rate to the activity, as well as its interaction with symptoms, including those of ischemic heart disease .
- Holter Monitor: can be used to help identify arrhythmias in patients with nonspecific symptoms, identify triggers and detect associated atrial arrhythmias.
- Transthoracic echocardiography (TTE): is the preferred initial imaging modality to evaluate atrial flutter. You can evaluate the size of the right and left atria, as well as the size and function of the right and left ventricles.
- Adenosine: This medication may be useful for diagnosing atrial flutter by transiently blocking the AV node.
Treatment for atrial flutter
The general objectives of treatment for symptomatic atrial flutter are similar to those for atrial fibrillation and include the following:
Control of ventricular frequency:
This can be achieved with drugs that block the AV node. Blockers of intravenous (IV) calcium channels (eg, verapamil and diltiazem) or beta-blockers may be used, followed by the start of oral agents.
Restoration of sinus rhythm:
This can be achieved by electrical or pharmacological cardioversion or radiofrequency ablation (RFA); successful ablation reduces or eliminates the need for long-term anticoagulation and antiarrhythmic medications
Prevention of recurrent episodes or reduction of their frequency or duration:
In general, the use of antiarrhythmic drugs in atrial flutter is similar to that of atrial fibrillation .
Prevention of thromboembolic complications:
Adequate anticoagulation, as recommended by the American College of Thoracic Physicians, has been shown to reduce thromboembolic complications in patients with chronic atrial flutter and in patients undergoing cardioversion.
Minimization of adverse effects of therapy:
Because atrial flutter is a non-fatal arrhythmia, carefully evaluate the risks and benefits of drug therapy, especially with antiarrhythmic agents.
Risks in the treatment:
In an acute context with pending hemodynamic collapse, follow the algorithms of advanced cardiac life support (ACLS) for adults to control atrial fibrillation and flutter. Consider immediate electrical cardioversion for patients who are hemodynamically unstable.
The main difference between atrial fibrillation and atrial flutter is that most cases of atrial flutter can be cured with radiofrequency ablation (RFA).
In all available studies, catheter ablation is superior to strategies for frequency control and rhythm control with antiarrhythmic drugs.
Consider catheter-based ablation as the first-line therapy in patients with typical atrial flutter if they are reasonable candidates. Ablation is usually performed as an elective procedure; however, it can also be done when the patient is in atrial flutter.
Given its high success rate and low complication rate, radiofrequency ablation is superior to medical therapy. Successful ablation reduces or eliminates the need for long-term antiarrhythmic medications and anticoagulation (unless the patient also has atrial fibrillation).
For the duration of atrial flutter less than 48 hours, try cardioversion as soon as possible. Similar to patients with atrial fibrillation, a decision is made about the need for postconversion anticoagulation after considering the risks of thromboembolism and hemorrhage in the individual patient.
Data from transesophageal echocardiography (TEE) studies indicate that post-conversion anticoagulation is a reasonable option because the rate of blood flow to the appendix is lower immediately after conversion.
Medications are usually given in acute settings or for patients who are not candidates for radiofrequency ablation (RFA).
Agents can be used to control ventricular rate, end acute episodes, prevent or decrease the frequency or duration of recurrent episodes, and prevent complications.
In general, it is accepted the start of drugs in outpatients in patients without underlying structural heart disease who are in sinus rhythm.
In addition, many specialists initiate outpatient pharmacological therapy in patients with atrial flutter therapy who expect ambulatory electrical cardioversion in the near future.
Certain medications, such as sotalol and dofetilide, should be started in a hospital setting because they can prolong the QT interval and be proarrhythmic. In any case, it is mandatory to follow the patient closely, with frequent electrocardiographic (ECG) or transtelephonic controls to detect possible signs of proarrhythmia.