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  Atrial Flutter

Typical Atrial Flutter

Key points

  • Atrial flutter is a specific supraventricular arrhythmia commonly seen in middle aged and elderly patients
  • It often occurs in patients with heart failure or high blood pressure
  • A small increased risk of stroke is associated with this arrhythmia and blood thinning is often recommended
  • Control with drugs alone is often ineffective, and recurrent symptoms are common
  • Curative ablation is possible in nearly all patients, although atrial fibrillation, a common related arrhythmia, is often seen following ablation

Introduction

Atrial flutter is a special type of supraventricular arrhythmia. It arises from the upper chamber on the right side of the heart, the right atrium. Electricity circulates around this chamber at a rapid rate and drives the main pumping chambers (ventricles) at a fast rate, often 100 to 150 beats per minute. The diagram above demonstrates the typical electrical circuit in atrial flutter.

Symptoms

Patients with atrial flutter often complain of tiredness or shortness of breath on exercise. The arrhythmia is often persistent and does not start and stop spontaneously like other supraventricular arrhythmias. Whilst palpitations may be experienced they are often not prominent.

Investigations

This usually includes, in addition to an ECG, a chest X-ray and an ultrasound scan (echocardiogram). More detailed investigations including an angiogram to look at the blood supply of the heart may be carried out. An ECG showing atrial flutter is shown. In addition routine blood tests are taken, including a test for thyroid function, as an overactive thyroid can precipitate this arrhythmia.

Treatments

The elements of treatment often include:

  1. Avoidance of excess caffeine and particularly alcohol

  2. Drugs to slow the heart rate. Drugs used for this might include beta blocking agents, calcium antagonists or digoxin

  3. Blood thinning agents, typically warfarin, to protect against blood clots and stroke

  4. Cardioversion. This involves the delivery of an electric shock across the heart to restore a normal rhythm. It is carried out under a brief general anaesthetic and is usually effective in the short term. Atrial flutter has a tendency to recur however

  5. More powerful drugs designed to prevent recurrences of the arrhythmia. They are effective in some patients, although one of the drugs often used, amiodarone, may have side effects limiting its use

  6. Radiofrequency ablation is effective at eliminating the arrhythmia in at least 90% of cases. The procedure is carried out in a very similar way to the ablation of other supraventricular arrhythmias (see ablation section). The main risk in having this procedure is an approximately 1% risk that slow heart beats may result, requiring treatment with a permanent pacemaker. Many patients with atrial flutter also experience a related arrhythmia called atrial fibrillation. Unlike atrial flutter, fibrillation arises from the left atrium. It is a more complex arrhythmia than atrial flutter (see atrial fibrillation section).

 


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