Atrial flutter(AFL) is a very common but abnormal heart rhythm which is similar to atrial fibrillation. Both conditions involve types of rapid heartbeat above the ventricles (supraventricular.) In patients with an atrial flutter, the upper chambers (known as the atria) of the heart beat too fast. The result is atrial muscle contractions that are faster than and typically out of sync with the lower chambers (known as the ventricles.) In a healthy heart it is important that all parts of the heart, specifically atria and ventricles, work together. Fortunately for patients, medication for atrial flutter is diverse and treatment is quick.
Regular Heart Function
The heart is an organ which pumps blood through our circulatory system. This system is designed to transport oxygen throughout our bodies. The motor of this system is the heart. Each beat of the heart is a very rapid series of two contractions. The first contraction starts in the upper chamber, the atria, while the second contraction is in the lower chamber, the ventricle. The atria is the first chamber blood fills, which is then pumped into the ventricle. The ventricle then pumps blood out into the aorta, which then feeds oxygen rich blood to the vessel of the body.
(SA) Node & (AV) Node
Under normal circumstances, these contractions (impulses) of the atria and ventricle are generated by the hearts “natural pacemaker” the sinus node or sinoatrial (SA) node, which is located in the right atrium. These electric impulses travel across the atria which generate a contraction. This electric current pauses very briefly at the atrioventricular (AV) node. The AV node is located in the upper part of the muscular tissue between both ventricles. This delay is important and vital as it gives the blood ample time to move from the atria into the ventricle.
Atrial flutter occurs when there are abnormal conduction circuits that develop inside the right atrium. This allows the atria to beat excessively fast, sometimes as much as 250 – 300 beats per minute. These rapid contractions are still slowed down when they arrive at the AV node but are still too fast. This type of fast paced rhythm is called tachycardia. Because atrial flutter is generated from the atria, it is known as supraventricular (a top the ventricles) tachycardia.
Atrial Flutter Vs Atrial Fibrillation
The main danger that can occur with atrial flutter is that the heart does not pump blood very well when it is beating too fast. In this case vital organs such as the brain, liver or kidneys may not receive enough oxygen rich blood. This can cause them to fail. Congestive heart failure, stroke and heart attack can result.
Atrial flutter is not the most common arrhythmia and typically is confused with atrial fibrillation. Although these two conditions are similar in ways there are many differences between atrial flutter vs atrial fibrillation.
During atrial fibrillation, electrical impulses start from many areas around both atria rather than the sinoatrial node. This results in chaotic impulses rather than organized ones. During atrial flutter, unlike atrial fibrillation, electrical impulses are organized and coordinated. However, the atria are contracting at a very high rate, upwards to 250 times per minute.
Another difference between atrial flutter vs atrial fibrillation is that patients with fibrillation put out about 10% less blood because the atria does not help pump blood into the ventricles. In atrial flutter, only every other impulses can be read through the atrioventricular node. This results in a ventricular rate of about 150 beats per minute.
Causes of Atrial Flutter
There are a vast list for causes of atrial flutter. Some of the causes of atrial flutter include abnormalities with the heart, either directly by diseases of the heart, or diseases elsewhere that still affect the heart. Heart conditions that are the cause of atrial flutter include hypertension, cardiomyopathy (especially when associated with congestive heart failure,) abnormal heart valves, enlarged heart chambers, atherosclerosis and heart attack. Diseases elsewhere in the body which affect the heart and are also a cause of atrial flutter include hyperthyroidism, pulmonary embolism, chronic obstructive pulmonary disease and emphysema. Substances can also be a contributing factor and cause of atrial flutter include alcohol and stimulants; including cocaine, amphetamines, cold medications and diet pills.
Symptoms of Atrial Flutter
There are many symptoms of atrial flutter. While some patients have bold symptoms of atrial flutter others have none. Some symptoms of atrial flutter include palpitations which is a rapid heartbeat or pounding sensation in the chest area. Other symptoms of atrial flutter include a “fluttering” feeling in the chest, anxiety, shortness of breath and weakness. Patients who have underlying heart or lung disease may also experience the above symptoms of atrial flutter including more significant symptoms which include angina pectoris, feeling faint or light headed and fainting.
You have the symptoms of atrial flutter, now what do you do? Your healthcare provider will most likely suspect an arrhythmia, which is an “out of rhythm” heartbeat. Because both these conditions have very similar symptoms, the first evaluation will focus on ruling out the most dangerous one. Fortunately, there is a single simple test that can tell a lot about the heart. This test is called an electrocardiogram (ECG.) The ECG is able to measure the electrical impulses which control the beating of the heart. The ECG is able to highlight the irregularities in these electrical impulses and abnormalities in the heart.
Another exam that can be done when patients have symptoms of atrial flutter is called echocardiogram. This is a painless ultrasound test which uses sound waves to show the inside of the heart while it is beating. This test can be done to identify heart valve problems, check ventricular function, or look for blood clots in the atria. This test uses the same technology used to look at a fetus during pregnancy.
Many times this heart condition is detected in people with absolutely no symptoms of atrial flutter. The condition is usually found when they are seeing their healthcare provider about other medical concerns or checkups. Your healthcare provider will note the unusual heart sounds or pulses and will then perform an ECG or an echocardiogram for a closer look.
There are many different methods and techniques in the treatment of atrial flutter. The main goal of any treatment is to first control the heart rate, second to restore the normal sinus rhythm and thirdly to prevent future flutter episodes which in turn prevents a possible stroke.
Treatment of Atrial Fibrillation
The first treatment of atrial flutter’s goal is to control the ventricular rate. If the patient is experiencing serious symptoms of atrial flutter such as congestive heart failure or heavy chest pains, the health care provider in an emergency facility will decrease your heart rate with either IV medications or an electrical shock called cardioversion or defibrillation. If you have no serious symptoms, you will most likely be given oral medication. Sometimes you may be required a combination of oral drugs to control your heart rate. On rare occasion, surgery may be done to control the hearts rhythm.
The second treatment of atrial flutter’s goal is to restore and maintain normal sinus rhythm. Some patients with newly diagnosed atrial flutter will naturally convert to a normal sinus rhythm spontaneously within 24 to 48 hours. The main goal of this treatment is to convert the atrial flutter back to a normal sinus rhythm and prevent any recurrence of an atrial flutter. It is important to note that not everyone with atrial flutter needs anti-arrhythmic medication. Also medical professionals will tailor each patient’s anti-arrhythmic medications to have desired effects without the possibilities of unwanted side effects, some which are potentially lethal.
The third treatment of atrial flutter’s goal is to prevent future episodes. This is usually done by taking daily doses of medication to keep the heart at a comfortable rate. Because there are many causes of atrial flutter, you have to work with your healthcare provider to find healthy balances in your daily life. A wholesome and regulated diet, regular physical exercise and a positive mindset help in the prevention of future atrial flutter episodes.
One of the most devastating atrial flutter complication is a stroke. This occurs when a piece of blood clot formed in the heart breaks off and blocks blood flow in the brain. Coexisting medical conditions such as congestive heart failure and mitral valve disease will increase the risk of stroke. Patients who have a consistent atrial flutter complications typically need a blood thinning medication called warfarin to lower the risk of stroke. This drug blocks specific factors in the blood that promotes clotting. Aspirin can also be used for people who cannot take warfarin, but this drug comes with its own side effects including excessive bleeding and stomach ulcers.
There are many different choices of medication for atrial flutter which depends on specific case, frequency of flutter, overall health, other medications you take and underlying cause of your atrial flutter. The classes of medication for atrial flutter are as follows:
These drugs chemically convert atrial flutter patterns back to a normal sinus rhythm, reduce the duration and frequency of an atrial flutter complication / episode and prevent future episodes. They are often given to prevent the return of atrial flutter post defibrillation. Examples include Sotalol, Procainamide, and Flecainide.
This class of medication for atrial flutter decreases electrical impulses through the AV and SA nodes, slowing down the heart rate.
These drugs slow down the rate of the heart by slowing conduction through the AV node. They also have an anti-arrhythmic effect on the atria.
These drugs reduce the functionality of factors in the blood which reduce clotting abilities. Because atrial flutter complications increases the risk of forming blood cloths you do not want any forming in the heart or blood vessels.
Calcium Channel Blockers:
These drugs are made to slow down the rate of the heart via slowing electrical conduction through the AV nodes.
Typically the prognosis for atrial flutter completely depends on the patient’s underlying medical problems and conditions. Any long term atrial arrhythmia can, over time, cause tachycardia induced cardiomyopathy. It is imperative to control the ventricular response rate and return the patient’s heart back to sinus rhythm. It is also important to educate yourself regarding medications and diet. Any patients taking warfarin should not make any major changed in their diet until talking to a health care professional. Exercise also plays a major role in keeping atrial flutter patients healthy, but may need to stop if they feel like their heart is out of rhythm.