Atrial flutter is a rhythmic, fast rhythm that occurs in the atria of the heart . An abnormal cell or group of cells in the atria (the small, upper chambers of the heart) cause them to fire off electrical impulses at a very fast, regular rate, often as high as 300 bpm (beats per minute) as if it is fluttering. During atrial flutter, the atrial rhythm is regular, and the ventricular rhythm may be regular or irregular. In both cases, the ventricles beat more slowly than the atria because the atrioventricular node cannot conduct electrical impulses at such a fast rate. In many individuals, the degree of block is variable - sometimes every other beat is transmitted, sometimes two beats are dropped before the third is transmitted, etc. Atrial flutter shares some features with AF in that it causes symptoms similar to those of AF, it can also increase the risk of stroke by blood clot formation in the heart which breaks off and migrates to the brain. An important difference with atrial fibrillation, though, is that many patients with atrial flutter can have their arrhythmia treated by catheter ablation with a very good probability of success. But in people with the condition called atrial flutter, the atria ""beat'' more often than the ventricles. This means that the atria have a shorter time to push all of their blood into the ventricles; and because of this, the ventricles may not fill up with enough blood. However, more often, these arrhythmias are caused by such conditions as rheumatic fever, high blood pressure, coronary artery disease, alcohol abuse, an overactive thyroid gland (hyperthyroidism), or a birth defect of the heart. It is also possible that the regular rhythm of atrial flutter may be followed by atrial fibrillation, where you experience an irregular and often rapid beating of the atria.
Atrial fibrillation and atrial flutter are more common among older people. When the heart ""beats,'' the atria push blood into the ventricles and the ventricles push blood out of the heart. Atrial flutter, depending on the ventricular rate, can impede cardiac output and lead to atrial thrombus formation, with risk of systemic embolization. This rhythm occurs most often in individuals with organic heart disease (ie: pericarditis , coronary artery disease , and cardiomyopathy ). These impulses are slowed before reaching the ventricles (large, lower chambers of the heart) which will beat at about half the rate of the atria. Over time, some blood inside the atria may stagnate, and clots may form. Pieces of the clot may break off, often shortly after atrial fibrillation converts back to normal rhythm—whether spontaneously or because of treatment. Atrial flutter can sometimes degenerate to atrial fibrillation and sometimes atrial fibrillation will organize back into atrial flutter and at times even one atrium may be in an organized rhythm and the other atrium may be in a disorganized rhythm. Atrial flutter can sometimes degenerate to atrial fibrillation and sometimes atrial fibrillation will organize back into atrial flutter and at times even one atrium may be in an organized rhythm and the other atrium may be in a disorganized rhythm. Atrial flutter may arise in otherwise healthy people without any evidence of heart disease, or may be secondary to scarring or stretching diseases of the atrium, just like AF. At times, when antiarrhythmic drugs are used for patients with atrial fibrillation, atrial fibrillation may be organized by the antiarrhythmic drug into atrial flutter and catheter ablation can then be successfully performed, a treatment sometimes referred to as hybrid therapy
Causes of Atrial flutter
The common Causes of Atrial flutter :
- Decreased blood flow to the heart (ischemia) due to coronary heart disease , atherosclerosis, or a blood clot
- Abnormal electrical properties of groups of heart cells
- Pericarditis, inflammation of the saclike covering of the heart (pericardium)
- Many patients with atrial flutter also have depressed LV function.
- High blood pressure (hypertension)
- An abnormally enlarged chamber of the heart (hypertrophy)
- Rapidly firing triggers (hot spots) -- often located in the veins that return blood from the lungs to the heart (pulmonary veins) -- that cause the atria to flutter
- These elements include an area of relatively slow conduction (the tricuspid valve isthmus).
Symptoms of Atrial flutter
Some are common Symptoms of Atrial flutter :
- Palpitations, or an unusual awareness of the rapid or forceful beating of the heart
- Dizziness, or lightheadedness
- Chest pressure or pain
- Shortness of breath
- Fainting (syncope)
- Low blood pressure, if the rapid heart beat decreases the pumping action of the heart
- Pulse may feel rapid, racing, pounding, fluttering, or it can feel too slow
- Pulse may feel regular or irregular
- Shortness of breath
- Breathing difficulty, lying down
Treatment of Atrial flutter
Here is the list of the methods for treating Atrial flutter :
- If you experience serious clinical symptoms, such as chest pain or congestive heart failure related to the ventricular rate, the health care provider in the emergency department will decrease your heart rate rapidly with IV medications or electrical shock (defibrillation).
- Most cases will require internal medicine or cardiology consultation.
- Surgery may be done to control rate, but this is rare.
- Blood pressure can be supported and rate controlled with medication.
- In addition to the treatments available to individuals in atrial fibrillation, there are a couple of treatment considerations that are particular to individuals with atrial flutter.
- Not everyone with atrial flutter needs anti-arrhythmic medication.
- Look for underlying causes. At times, treatment of the underlying disorder (eg, thyroid disease, valvular heart disease) is necessary to effect conversion to sinus rhythm.
- Coexisting medical conditions, such as congestive heart failure and mitral valve disease, significantly increase the risk of stroke.
- In some cases, a procedure called catheter ablation therapy may be necessary, where radio frequency waves are used to destroy an abnormal electrical pathway in the heart.