What is flutter and why should I Care?
Currently, atrial flutter is successfully "cured" by radiofrequency catheter ablation; but treatment to restore atrial fibrillation to sinus rhythm has been the traditional use of medications and external cardioversion. External cardioversion is delivery of high energy shocks of 50 to 300 joules through two defibrillator pads attached to the chest.
What is flutter and should you focus on it?
If it persists, your doctor may pursue any of the following treatments: Treatment of any underlying conditions Catheter ablation — procedure to destroy the errant electrical pathways; performed together with an electrophysiological... Cardioversion — small, controlled shock to …
What are some alternatives to flutter?
What other treatments are there for atrial flutter? When medicines don’t work, other treatments can be done, such as: Cardioversion via electrical shock. Catheter ablation. Prevention How can I reduce my risk of atrial flutter? Although you can’t control some of the risk factors for atrial flutter, limiting your alcohol intake can help.
What is best treatment for atrial flutter?
Currently, atrial flutter is successfully "cured" by radiofrequency catheter ablation; but treatment to restore atrial fibrillation to sinus rhythm has been the traditional use of medications and external cardioversion.
Should atrial flutter be treated?
Sometimes, atrial flutter goes away by itself and no further action is needed. If it persists, your doctor may pursue any of the following treatments: Treatment of any underlying conditions. Catheter ablation — procedure to destroy the errant electrical pathways; performed together with an electrophysiological study.
What do you give for a flutter?
Initial treatment of atrial flutter targets the rate control (which is frequently ~150 BPM). Drugs of choice include beta blockers such as esmolol (0.5 mg/kg IV bolus followed by 50-300 ucg/kg/min) and propranolol, or calcium channel blockers such as verapamil (5-10 mg IV) or diltiazem.
What is the major cause of atrial flutter?
It's caused by an abnormal electrical circuit in the upper chambers of the heart (atria) that makes the atria beat quickly and flutter instead of fully squeezing. It can result in fast heart rates and a heart that doesn't work as well as it should. This increases the risk for stroke and may cause you to feel poorly.
Can you live a long life with atrial flutter?
The good news is that although AF is a long-term condition, if managed correctly, you can continue to lead a long and active life. There are a number of steps you can take that will help you manage your condition, lower your risk of stroke and relieve any worries you may have.
How do paramedics treat flutters?
Refer to local protocols for emergency medical services (EMS) management. Atrial flutter in an unstable patient should be treated immediately with synchronized cardioversion. Unstable patients are those with ongoing chest pain, severe shortness of breath, altered level of consciousness, or hypotension.
Which is worse atrial fib or flutter?
Both heart diseases have the potential of becoming serious. However, many doctors and other health care professionals consider atrial flutter to be less serious than atrial fibrillation because flutter symptoms tend to be less severe and flutter waves have a less risk of embolization (clot formation).
What's the difference between AFib and flutter?
Normally, the top chambers (atria) contract and push blood into the bottom chambers (ventricles). In atrial fibrillation, the atria beat irregularly. In atrial flutter, the atria beat regularly, but faster than usual and more often than the ventricles, so you may have four atrial beats to every one ventricular beat.
How to control atrial flutter?
Whenever rapid control of the ventricular response rate to atrial flutter is desirable, use of either an intravenous calcium channel blocking agent (verapamil or diltiazem) or an intravenous β blocking agent (usually esmolol, although propranolol or metoprolol can also be used) is usually effective. Aggressive administration of a digitalis preparation, usually intravenously, to control ventricular rate (it might also convert the atrial flutter either to atrial fibrillation with a controlled ventricular response rate or to sinus rhythm) is also acceptable, but generally is not the treatment of choice except in the presence of pronounced ventricular dysfunction. DC cardioversion of atrial flutter to sinus rhythm has a very high likelihood of success. When this mode of treatment is selected, it may require as little as 25 joules, although at least 50 joules is generally recommended because it is more often successful. Because 100 joules is virtually always successful and virtually never harmful, it should be considered as the initial shock strength.
What antiarrhythmics can be used to treat atrial flutter?
Antiarrhythmic drug treatment can be used to convert atrial flutter to sinus rhythm. Three drugs—ibutilide, flecainide, and propafenone—have a reasonable expectation of accomplishing this. Ibutilide, which can only be used intravenously, is associated with a 60% likelihood of converting atrial flutter to sinus rhythm. 16 Because ibutilide dramatically prolongs ventricular repolarisation, and consequently the Q-T interval, there is a small incidence of torsades de pointes associated with its use. 17 However, these episodes, should they occur, are usually self limited, and because of the short half life of this drug, the period of such risk is quite brief, usually less than one hour. Nevertheless, one should be prepared to administer intravenous magnesium and even perform DC cardioversion to treat a prolonged episode of torsades de pointes should it occur when using ibutilide. Flecainide and propafenone, when used intravenously 18 or when used orally but in a single high dose (300 mg for flecainide or 600 mg for propafenone) also may be effective in cardioverting this rhythm to sinus. When using either of these drugs, the atrial rate may slow dramatically—for example, to 200 bpm. Therefore, it is best given with a calcium channel blocker or β blocker to prevent the possibility of 1:1 AV conduction of the significantly slowed atrial flutter rate. Antiarrhythmic drug treatment also may be used before performing either DC cardioversion or rapid atrial pacing: (1) to slow the ventricular response rate (with a β blocker, a calcium channel blocker, digoxin or some combination of these drugs); (2) to enhance the efficacy of rapid atrial pacing in restoring sinus rhythm (use of procainamide, disopyramide or ibutilide); or (3) to enhance the likelihood that sinus rhythm will be sustained following effective DC cardioversion (use of a class IA, class IC or class III antiarrhythmic agent).
How to restore sinus rhythm?
When atrial flutter is diagnosed , three options are available to restore sinus rhythm: (1) administer an antiarrhythmic drug; (2) initiate DC cardioversion; or (3) initiate rapid atrial pacing to terminate the atrial flutter (fig 4 ). Selection of acute treatment for atrial flutter with either DC cardioversion, atrial pacing or antiarrhythmic drug therapy will depend on the clinical presentation of the patient and both the clinical availability and ease of using these techniques. Since DC cardioversion requires administration of an anaesthetic agent, this may be undesirable in the patient who presents with atrial flutter having recently eaten or the patient who has severe chronic obstructive lung disease. Such patients are best treated with either antiarrhythmic drug therapy or rapid atrial pacing to terminate the atrial flutter, or with an AV nodal blocking drug to slow the ventricular response rate. When atrial flutter is associated with a situation requiring urgent restoration of sinus rhythm—for example, 1:1 AV conduction or hypotension—prompt DC cardioversion is the treatment of choice. For the patient who develops atrial flutter following open heart surgery, use of the temporary atrial epicardial wire electrodes to perform rapid atrial pacing to restore sinus rhythm is the treatment of choice (fig 4 ).
What is the most common tachyarrhythmia after atrial fibrillation?
After atrial fibrillation, atrial flutter is the most important and most common atrial tachyarrhythmia. Although it was first described 80 years ago, techniques for its diagnosis and management have changed little for decades. The diagnosis rested almost entirely with the 12 lead ECG, and treatment options included only the use of a digitalis compound to slow and control the ventricular response rate, and/or the use of either quinidine or procainamide in an attempt to convert the rhythm to sinus rhythm or to prevent recurrence of atrial flutter once sinus rhythm was established.
How does atrial flutter occur?
While those studies have been and continue to be most helpful, a series of studies in patients—principally using catheter electrode mapping and pacing techniques—has established that classical atrial flutter is caused by a re-entrant circuit confined to the right atrium in which the impulse travels up the atrial septum, with epicardial breakthrough superiorly in the right atrium where the impulse then travels inferiorly down the right atrial free wall to re-enter the atrial septum (fig 1 ). 2-7 When the circulating wave front re-enters the atrial septum, it travels through an isthmus bounded by the inferior vena cava, Eustachian ridge, the coronary sinus os on one side and the tricuspid valve annulus on the other side (the “atrial flutter isthmus”). Atrial flutter caused by this mechanism is called typical atrial flutter, 8 although it also has been called common atrial flutter and counterclockwise atrial flutter. A 12 lead ECG during typical atrial flutter with characteristic negative “sawtooth” atrial flutter waves in leads II, III, and aVF is shown in fig 2. It is also recognised that impulses can travel in this re-entrant circuit in the opposite direction, so that the impulse travels down the atrial septum and breaks through to the epicardium via the same atrial flutter isthmus to travel up the right atrial free wall and then re-enter the septum superiorly (fig 1 ). 3 This form of atrial flutter is called reverse typical atrial flutter, 8 although it has in the past been called atypical atrial flutter, clockwise atrial flutter, uncommon atrial flutter, and rare atrial flutter. A 12 lead ECG during reverse typical atrial flutter with characteristic positive flutter waves in leads II, III, and aVF is shown in fig 3.
What causes atrial flutter?
9 Interestingly, it has recently been shown 10 that when atrial flutter does occur chronically in patients following repair of congenital heart defects, it is usually caused by a re-entrant circuit that includes the atrial flutter isthmus. Additionally, a left atrial flutter is now recognised that is thought generally to circulate around one or more of the pulmonary veins or the mitral valve annulus, but this re-entrant mechanism has not been well characterised. And finally, there are some forms of atrial flutter which are quite unique, and have now been called truly atypical atrial flutter. 8
Is atrial flutter a treatment?
Recent improvements in the efficacy of catheter ablation techniques and the long recognised difficulty in achieving adequate chronic suppression of atrial flutter with drug treatment have significantly affected the approach to long term treatment of atrial flutter. In short, if atrial flutter is an important clinical problem in any patient, characterisation of the mechanism of atrial flutter followed by catheter ablation as treatment of choice (cure) is now recommended.
Why is flutter important?
Atrial flutter is important not only because of its symptoms but because it can cause a stroke that may result in permanent disability or death.
Where is atrial flutter cured?
While the symptoms are similar, the treatments may differ. Typical atrial flutter is localized to the right atrium. This type of atrial flutter can be cured with a short outpatient catheter ablation procedure. Atypical atrial flutter refers to atrial flutter arising in the left atrium.
What is atypical atrial flutter?
Atypical atrial flutter refers to atrial flutter arising in the left atrium. Most types of atypical atrial flutter can also be treated with catheter ablation, but the procedure is longer and more involved.
How to diagnose flutter in heart?
Atrial flutter is normally diagnosed in your physician's office using an electrocardiogram (ECG or EKG). If the diagnosis is still in question, your doctor may recommend a Holter monitor, an event monitor or an electrophysiological study, during which a narrow, flexible tube called a catheter is threaded through a vein to your heart under light sedation. Fine wires inside the catheter can help pinpoint the abnormal signal.
Which is less effective, catheter ablation or antiarrhythmics?
Medications to control the heart rhythm, called antiarrhythmics, may be less effective than catheter ablation
Is a flutter atypical or atypical?
Atrial flutter is classified as typical or atypical (non-typical) depending on the location of the short circuit — the pathway that allows the electrical signal to move too fast around the heart. While the symptoms are similar, the treatments may differ.
Does a flutter cause symptoms?
Atrial flutter may cause no symptoms at all, or they may cause any of the following:
How to treat a flutter?
The first step in treatment is to restore a normal rate and sinus rhythm. There are two ways to do this: medication and defibrillation. Electrical cardioversion: The doctor gives your heart a shock to regulate your heartbeat.
What to do if you have a flutter?
If you've been diagnosed and are being treated for atrial flutter, go immediately to a hospital emergency department if you: Have severe chest pain.
How long does a paroxysmal atrial flutter last?
Paroxysmal atrial flutter can come and go. An episode of atrial flutter usually lasts hours or days.
What is the danger of atrial flutter?
The main danger with atrial flutter is that your heart doesn’t pump blood very well when it beats too fast.
What causes a flutter in the heart?
Heart diseases or problems that can cause atrial flutter include: Ischemia: Lower blood flow to the heart due to coronary heart disease, hardening of the arteries, or a blood clot. Hypertension: High blood pressure. Cardiomyopathy: Disease of the heart muscle. Abnormal heart valves: Especially the mitral valve.
Can you get treatment for atrial flutter?
Because other conditions can cause similar symptoms, the doctor will want to rule out the most dangerous ones. Also, you can’t get treatment until the doctor knows your specific arrhythmia type.
Can a doctor know if you have an atrial flutter?
Doctors don’t always know. In some people, no root cause is ever found. But atrial flutter can result from:
How to diagnose atrial flutter?
Diagnosing Atrial Flutter. Doctors use electrocardiography (ECG or EKG) to diagnose atrial flutter. This test measures the electrical activity of the heart. You can have an EKG at the doctor’s office or in the hospital. An EKG is a painless, non-invasive test that usually takes just a few minutes. During an EKG:
What are the causes of atrial flutter?
Alcohol and stimulants such as diet pills, cold medicines, and caffeine can contribute to symptoms of atrial flutter.
What causes a flutter in the upper chamber of the heart?
A heart attack, coronary artery disease, or previous heart or chest surgery on the upper chambers of your heart can also increase your risk. Alcohol and stimulants such as diet pills, cold medicines, and caffeine can contribute to symptoms of atrial flutter.
What is the cause of a fluttering heart?
Atrial flutter is a type of arrhythmia (heart rhythm disorder) caused by a “short circuit” in the electrical system. The heart’s upper chambers beat too quickly, prompting the upper heart to beat as many as 300 times per minute or more and the lower heart to beat as many as 100-200 times per minute. When the lower heart rate is higher ...
What is the normal heart rate for a flutter?
This results in a normal resting heart rate of 60 to 100 beats per minute.
Is flutter a life threatening condition?
Atrial flutter is not life-threatening. But it can cause serious side effects, including: clots that can travel to the brain and lead to a heart attack or stroke, cardiomyopathy, which occurs when the heart muscle becomes weak and tired, and. atrial fibrillation (AFib).
What are the treatments for atrial flutter?
There are effective treatments for atrial flutter, including medication or procedures designed to scar small areas of heart tissue (ablation).
What is a flutter in the heart?
Atrial flutter is a type of heart rhythm disorder in which the heart's upper chambers (atria) beat too quickly.
Is atrial flutter a disorder?
Atrial flutter is similar to atrial fibrillation, a common disorder that causes the heart to beat in abnormal patterns. People with atrial flutter have a heart rhythm that's more organized and less chaotic than that of atrial fibrillation. Sometimes you may have episodes of both atrial flutter and atrial fibrillation.
Why do doctors use atrial flutter ablation?
Doctors use atrial flutter ablation to control the signs and symptoms associated with atrial flutter. Atrial flutter ablation may restore a normal heart rhythm, which may improve your quality of life.
Where is flutter ablation done?
Atrial flutter ablation is done in the hospital. You'll receive a medication called a sedative that helps you relax. Once the sedative takes effect, a small area near a vein, usually in your groin, is numbed. The doctor inserts a long flexible tube (catheter) into the vein.
What is the purpose of scarring in the atrial flutter?
Heat (radiofrequency energy) is applied to the target area, damaging the tissue and causing scarring. The scarring helps block the electrical signals that are causing your atrial flutter.
How does a doctor do ablation?
The doctor inserts a long flexible tube (catheter) into the vein. He or she carefully guides the catheter into your heart. Sensors on the tip of the catheter send electrical impulses and record your heart's electricity. Your doctor uses this information to determine the best place to apply the ablation treatment.
Can you have an atrial flutter after cardiac ablation?
Most people see improvements in their quality of life after this type of cardiac ablation, but there's a chance your atrial flutter may return. If this happens, the procedure may be repeated or you and your doctor might consider other treatments.
Mechanism
Classification
- All these types of atrial flutter fall under the category of type I atrial flutter as described by Wells and colleagues.11They are distinguished by the fact that they can always be interrupted by rapid atrial pacing, and have a rate range between 240340 beats/min (bpm).11 Type II atrial flutter11is a more rapid atrial flutter (rates >340 bpm) which is still being characterised. It is presently though…
Signs and symptoms
- Atrial flutter typically is paroxysmal, usually lasting seconds to hours, but on occasion lasting longer. Occasionally, it is a persistent rhythm. Atrial flutter as a stable, chronic rhythm is unusual, as it usually reverts either to sinus rhythm or to atrial fibrillation, either spontaneously or as a result of treatment. However, atrial flutter has been reported to be present for up to 20 years or …
Treatment
- When atrial flutter is diagnosed, three options are available to restore sinus rhythm: (1) administer an antiarrhythmic drug; (2) initiate DC cardioversion; or (3) initiate rapid atrial pacing to terminate the atrial flutter (fig 4). Selection of acute treatment for atrial flutter with either DC cardioversion, atrial pacing or antiarrhythmic drug t...
Diagnosis
- Similarly, when incisional re-entrant atrial flutter is identified by electrophysiological mapping techniques, a vulnerable isthmus usually can be identified and successfully ablated using radiofrequency catheter ablation techniques.9 There is insufficient information available to discuss the likely efficacy of successful radiofrequency ablation techniques to cure left atrial flu…
Prognosis
- Atrial flutter is quite difficult to suppress completely with drug treatment. In fact, based on available long term data, drug treatment offers a limited ability to maintain sinus rhythm without occasional to frequent recurrences of atrial flutter, even when multiple agents are used. This is among the reasons why this form of therapy is no longer the long term treatment of choice in m…
Medical uses
- In the past, standard antiarrhythmic drug treatment consisted of administration of a class IA agent (quinidine, procainamide, or disopyramide) in an effort to prevent recurrence. However, recent studies indicate that the type IC antiarrhythmic agents flecainide and propafenone are as effective, if not more effective, are generally better tolerated, and have less organ toxicity than cl…
Prevention
- Although one study found neither atrial clot formation nor stroke associated with atrial flutter in a relatively small cohort of patients after open heart surgery, the association of the potential risk of stroke with atrial flutter has now been established.14 15Other data support this association. Thus, atrial flutter and atrial fibrillation often co-exist in patients. Additionally, using transoesophageal …
Funding
- Supported in part by grant RO1 HL38408 from the National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA.