Also called atrial flutter (AFL), it is an abnormal heart rhythm, similar to atrial fibrillation, the most common.
Both conditions are types of supraventricular tachycardia (above the ventricles).
In the AFL, the heart’s upper chambers (atria) are too fast, which produces atrial muscle contractions that are faster than the lower chambers (ventricles) and are not synchronized with them.
The heart’s electrical system is the source of energy that makes the heartbeat. 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 from the sinoatrial node (SA), a small bundle of tissue located in the right atrium. The stimulation 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 causes the pulse that we feel in our wrist or neck.
The electrical signal travels along a path inside the right atrium with atrial flutter. It moves in an organized abnormal circular motion, or “circuit,” causing the atria to beat faster than the ventricles of your heart.
It was flapping headphones, a heart rhythm disorder similar to the more common AFib.
In AFib, the heart beats fast and does not have a regular pattern or rhythm. The heart beats abnormally fast with atrial flutter but in a familiar way. The short but regular practice of fluttering headphones makes it unique.
The atrial flutter performs a 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 have a constant heart rate, even though it is faster than usual.
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 other 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.
This means that the ventricles are beating too fast. When the ventricles beat too fast for long periods, 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 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 help 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 evaluate the response of the ventricular rate to the activity and its interaction with symptoms, including those of ischemic heart disease.
- Holter Monitor can 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 determine the size of the right and left atria and the size and function of the right and left ventricles.
- Adenosine: This medication may help diagnose atrial flutter by blocking the AV node transiently.
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 (e.g., 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, antiarrhythmic drugs in atrial flutter are similar to that of atrial fibrillation.
Prevention of thromboembolic complications:
As recommended by the American College of Thoracic Physicians, Adequate anticoagulation has been shown to reduce thromboembolic complications in patients with chronic atrial flutter and 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 advanced cardiac life support (ACLS) algorithms for adults to control atrial fibrillation and flutter. Consider immediate electrical cardioversion for hemodynamically unstable patients.
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. Like patients with atrial fibrillation, a decision is made about the need for post-conversion anticoagulation after considering the risks of thromboembolism and bleeding in the individual patient.
Data from transesophageal echocardiography (TEE) studies indicate that post-conversion anticoagulation is a reasonable option because 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 control ventricular rate, end acute episodes, prevent or decrease the frequency or duration of recurrent episodes, and prevent complications.
In general, it is accepted that start drugs in outpatients in patients without underlying structural heart disease in sinus rhythm.
In addition, many specialists initiate outpatient pharmacological therapy in patients with atrial flutter therapy who expect ambulatory electrical cardioversion shortly.