Sunday, July 27, 2014

What is Atrial Flutter?

Atrial flutter is common heart rhythm problem that may cause the heart to race at very fast rates.  It typically causes fatigue, shortness of breath and other symptoms. Patients often end up seeking urgent medical care because of very fast heart rates and the symptoms it causes.

In many aspects atrial flutter and atrial fibrillation are similar (such as stroke risk, symptoms and risk of congestive heart failure), but they are in fact two distinct rhythm problems. Atrial fibrillation and atrial flutter are commonly seen together, but the treatment for these conditions can be different (specially in terms of catheter ablation).

Atrial Flutter
Atrial flutter: the normal electrical activation of the heart is replaced by
abnormal activity, where the impulse starts rotating around the tricuspid valve

What Causes Atrial flutter?

In patients with atrial flutter the electrical activation of the heart starts rotating around the tricuspid valve – a valve that separates that right upper and lower chamber. This starts what we call reentry, where the electrical activity spins around the valve in a never-ending fashion.

The AV node will regulate how many impulses will go down into the ventricles, and hence, how fast your heart will be. While most patients with atrial flutter have a fast heart beat, it is not unusual for some patients to develop very slow heart rates.

Problems caused by Atrial Flutter

Much like atrial fibrillation, atrial flutter can cause strokes, symptoms and congestive heart failure. Not uncommonly, patients with atrial flutter present with very fast heart rates and prompt treatment to slow down the heart or to restore normal sinus rhythm is very important in order to prevent other problems

Common symptoms of atrial flutter:

  • Palpitations
  • Irregular heart beat
  • Fatigue
  • Shortness of breath
  • Chest pain
  • Dizziness
  • Heart racing
  • Heart fluttering

Treatment for Atrial Flutter

Patients with atrial flutter need to be on some form of therapy to prevent strokes (read section about strokes and the new blood thinners).

Oftentimes prompt care is needed because the heart rate is very fast and needs to be slowed down quickly. IV medications and sometimes cardioversion can be used in these situations.

Atrial flutter commonly recurs after patients are cardioverted back into normal rhythm. Medications to prevent recurrences, called anti-arrhythmics may be used.

Most patients with atrial flutter are better treated with catheter ablation.

Atrial Flutter Ablation

Atrial flutter ablation is the only definitive treatment option for patients with flutter and it has very high cure rates (over 95%), with very low risks. The procedure is commonly done as an outpatient, same day procedure.

IV lines are inserted into the leg veins. We then introduce via those lines catheters that will go into the heart to “map” the arrhythmia. Mapping an arrhythmia means to study and find out what the pathway of the abnormal electrical impulses is.

Ablation of atrial flutter is performed by cauterizing a small area in the heart that is part of the flutter circuit. In other words, the cauterization is performed in an area that the electricity passes through when spinning around the valve. By cauterizing, we create a road block which won’t allow the abnormal circuit to continue and the arrhythmia stops.

Most patients can go home the same day, about 6 hours after the procedure.

In summary, atrial flutter is a condition that can cause some of the same problems seen with afib, such as increased risk of stroke and symptoms. However, flutter is caused by abnormal electrical activity around the tricuspid valve. Although it can be treated with medications, it frequently recurs. Catheter ablation is considered the best option for patients with atrial flutter.

Jose Osorio, MD

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