Atrial flutter is a common abnormal, fast heart rhythm which originates from the top chambers of the heart (the atria). The atria are beating too fast and out of sync with the lower chambers (ventricles). This rhythm can be present all the time or it can be intermittent. The electrical system of the heart is responsible for making the heart beat. Electrical impulses usually travel along a pathway in the heart and ensure that the atria and ventricles work together too pump blood. In atrial flutter the electrical signal loops around the atrium in a circular motion causing the atria to beat much faster than the ventricles. As this make them contract faster than normal.
Some people don’t realise they have atrial flutter and the heartbeat can remain regular, It may be diagnosed on a routine heart tracing (ECG) done for another reason.
Symptoms of atrial flutter include:
There are some common reasons that make people more likely to develop atrial flutter such as coronary artery disease or structural heart disease. Lung disease such as COPD or sleep apnoea and thyroid disease can also make it more likely for you to develop atrial flutter. Other potential causes include alcohol abuse.
Atrial flutter itself is not usually life threatening. The abnormal contraction and fluttering of the atria may cause stagnation of the blood within the heart. This means that the blood is more likely to form a clot and, in some people, this clot can travel to the brain and cause a stroke. Also atrial flutter can cause the heart to beat rapidly over long periods of time, which can lead to the heart muscle becoming weak and subsequent heart failure.
Electrocardiogram (ECG): An ECG is a snapshot of your heart’s electrical activity. Stickers (electrodes) are attached to your chest, arms and legs. These measure the rate and rhythm of your heart. Atrial flutter has a very characteristic appearance on the ECG.
Ambulatory ECG monitor: This is a portable ECG that can be worn from a day to a week. And records your heart rhythm continuously Newer monitors are available in the form of a patch which sticks on your chest.
Echocardiogram: An ultrasound that examines the structure and function of the heart.
Atrial flutter can be treated in a number of different ways. Your Cardiologist will discuss the various options with you in detail and decide which treatment type is best for you. Some of the common ways of treating atrial flutter are detailed below.
One of the most important considerations in the treatment of atrial flutter is to assess whether patients need a blood thinner (anticoagulant). Another important part of treating atrial flutter is treating the underlying cause, if there is one, such as heart, lung or thyroid disease.
Medications: may be used but atrial flutter can be resistant to medications.
Cardioversion, where the heart is electrically shocked back to a normal rhythm may be used but carries a high recurrence rate.
Catheter ablation: Catheter ablation is usually the first line treatment for atrial flutter and is theonly curative treatment for atrial flutter. In trials it has been shown to be better than drugs or cardioversion.
A catheter ablation is a minimally invasive procedure (not surgery), where fine wires are passed into the vein at the top of the leg and through the veins to the heart and radiofrequency energy is delivered within the heart to treat the abnormality.
Catheter ablation is performed by a highly skilled team who work alongside your electrophysiologist (heart rhythm doctor). The electrical activity of the heart can be studied. As atrial flutter is a circuit looping around the right atrium this can be treated by delivering radiofrequency energy to this area of the heart. Doing this doesn’t damage the heart but stops that very small part from being able to transmit electrical impulses and therefore the atrial flutter terminates.
A catheter ablation for atrial flutter is a very safe procedure which carries a high success rate,> 90%. It can be performed under local anaesthetic with sedation or general anaesthetic and is usually performed as a day case procedure. The risks from the procedure are very small and include bleeding in the leg or around the heart and a very small risk of needing a pacemaker.