Atrial flutter

Personalised and effective atrial flutter care for your condition 

• We're number one for private cardiac care: We've provided care for more than 79,000 cardiac patients in the last three years and 99% would recommend us to friends and family. 
• Specialist cardiac and arrhythmia teams: Our leading consultants are supported by multi-disciplinary teams to ensure you receive outstanding treatment and care for your condition.
• Treatment tailored to you and your condition: If you require atrial flutter treatment, your consultant will recommend the most effective options for you.
• Advanced technology and outstanding facilities: We have a network of five cardiac centres and 15 outpatient and diagnostic facilities, providing quality atrial flutter care to suit your needs.
• Fast diagnosis: We'll confirm an appointment with an atrial flutter specialist within 24 hours and you'll get your results within 48 hours of your tests.

What is atrial flutter?

Atrial flutter (also referred to as AFL) is a cardiac arrhythmia condition that's diagnosed when a person has an abnormally fast heartbeat. The condition is caused by electrical impulses in the heart that result in its top chambers (atria) beating faster than the bottom chambers (ventricles). This means that the overall heart rhythm becomes out of sync and the rapid heartbeat is experienced in a consistent pattern.

A normal resting heart rate is considered to be between 60 and 100 BPM. But, when a person has atrial flutter, the upper chambers of the heart can beat 250 to 350 times per minute. This then results in a faster response in the lower chambers (typically 150 BPM or more).

The rapid heartbeat means that the chambers are unable to be filled with blood properly and the upper chambers can't empty the blood quickly enough. In turn, the body receives less blood than it should. 

Atrial flutter vs atrial fibrillation

Some people confuse atrial flutter with atrial fibrillation (Afib) but there is a clear difference. With AFL, the heartbeat is fast but remains regular. When someone experiences Afib, the heartbeat is not only fast but also irregular. It is possible to have both conditions at the same time and, often, treatment can be similar for both.

Types of atrial flutter

There are three types of atrial flutter which typically produce similar symptoms but it's important to be correctly diagnosed so you can be given the most effective treatment: 

• Typical atrial flutter: this is the most common (accounting for 90% of cases) and occurs in the right atrium (upper chamber) with electrical signals moving in an anticlockwise direction
• Atypical atrial flutter: this is the least common (accounting for 10% of cases) and occurs in the left atrium

How serious is atrial flutter? 

If not properly diagnosed and treated, atrial flutter can cause other serious conditions such as blood clots which can lead to a stroke or heart attack and a weakened heart muscle. You might also experience low blood pressure which, if left unmanaged, can lead to heart failure. 

But, with the correct diagnosis and treatment options for atrial flutter, the symptoms and any further risks can be well managed. 

What are the causes of atrial flutter? 

While atrial flutter is directly caused by abnormal electrical signals in the heart, it can be associated with various underlying conditions. These can include: 

• Diseases affecting the structure of the heart: these include valve disease, heart muscle damage, heart failure, or congenital defects. 
• High blood pressure
• Overactive thyroid 
• Coronary artery disease 
• Previous cardiac surgery 
• Sleep and breathing associations including COPD and sleep apnoea 

It's important to be aware that this doesn't mean everyone with one of these conditions will experience atrial flutter and it’s recommended that you speak to a doctor to understand your circumstances.

What are the risk factors associated with atrial flutter? 

Atrial flutter is more common in those over the age of 50 due to the increased risk of underlying factors and related conditions such as high blood pressure and heart disease. But there are other risks associated with atrial flutter that may increase the likelihood of the condition developing:

• Stress
• Excessive alcohol use 
• Lung disease
• Diabetes 
• Obesity 
• Sleep apnoea  

As with many heart-related conditions, reducing your alcohol intake, getting adequate sleep and maintaining a healthy diet and lifestyle might help to reduce your chances of experiencing atrial flutter. 

How is atrial flutter diagnosed? 

Often, an atrial flutter diagnosis is made after you've experienced symptoms. The condition is also sometimes diagnosed after routine checks. 

If you're experiencing atrial flutter symptoms, a GP or other health professional will usually check your pulse and ask questions about your symptoms and previous medical history. They might recommend further investigations or tests such as:

• Electrocardiogram (ECG): This is the main way to diagnose atrial flutter. An ECG measures the electrical activity of the heart, and abnormalities can help to identify atrial flutter.
• Ambulatory electrocardiogram: This is a portable ECG monitor that is worn over a period between one to seven days to give a more accurate picture of your heart's electrical activity and identify infrequent episodes.
• Cardiac event recorder: This is a small electrical device that you use to record whenever you feel symptoms and is usually kept for up to 30 days.
• Echocardiogram (ultrasound of the heart): This uses sound waves to create an image of your heart, helping to assess its structure and function and rule out other causes of symptoms.
• Blood tests: These may be used to check for underlying conditions like thyroid problems or electrolyte imbalances that could contribute to atrial flutter.

Additional tests like electrophysiological studies and cardiac stress tests might be used to gain further information about the causes of your arrhythmia and how your heart responds to exercise.

Once your atrial flutter diagnostic tests have been completed, your consultant will talk to you in detail about your results. You'll also be advised of any further investigations or treatments for atrial flutter that are needed, based on your individual condition.

Treatment of atrial flutter 

Atrial flutter management or treatment is typically based on the severity of your condition. Treatments and therapy for atrial flutter focus on reducing the risk of serious heart problems and managing your abnormal heartbeat.

Your consultant will consider and recommend the most suitable and effective treatment option for you, which might include certain medications, procedures or a combination of both.

Atrial flutter medication  

You might be offered medications to control your heart rhythm, reduce your risk of stroke or manage your heart rate. 

• Beta blockers such as propranolol, bisoprolol or atenolol slow the heart rate down and help lower blood pressure
• Calcium channel blockers including non-dihydropyridines such as diltiazem and verapamil help slow your heart rate and control abnormally fast heart rhythms 
• Flecainide or amiodarone are both often prescribed for arrhythmias and can help return the heart rate to normal or reduce the frequency of abnormal rhythms occurring 

You might also have treatment for any underlying condition that could have contributed to your atrial flutter such as diabetes or an overactive thyroid. 

Side effects of atrial flutter medication 

Depending on the medication you're prescribed, you might experience some side effects, most of which are mild and manageable. These might include: 

• Lethargy: This is common when you first start taking beta blockers but typically settles within a few days
• Skin sensitivity: Amiodarone can cause an increased risk of getting sunburn
• Over or underactive thyroid: Amiodarone can also cause changes to your thyroid function which can be managed with additional medication
• Stomach upset: This can sometimes happen when taking medication for arrhythmias
• Increased risk of cardiac death: Rarely, atrial flutter medication can cause a more serious arrhythmia which, in a small number of cases, can lead to sudden cardiac death

Your consultant or GP will discuss the potential side effects and your individual risk factors before prescribing any of these medications. 

Medical procedures for atrial flutter

Atrial flutter can often be successfully treated with a medical procedure that aims to cure the abnormal heart rate. We’re the leading provider of private electrophysiological procedures, including cardioversions, ablations and pacemakers, in London. 

At HCA UK, we treat (X percentage) of those with atrial flutter with one of the following, and deliver excellent outcomes with all our treatments:

• Electrical cardioversion: This atrial flutter therapy involves sending controlled electrical signals to your heart to restore a normal rhythm. It can be carried out as an external cardioversion, under general anaesthetic, where electrodes placed on the chest deliver controlled electric shocks to your heart. It can also be done internally with a local anaesthetic where a small tube is inserted into a vein at the top of your leg. In this case, a small wire is inserted into your heart to deliver the electric shock.
• Catheter ablation: A minimally invasive atrial flutter treatment, this destroys the damaged heart tissue that's responsible for your abnormal heart rate. Usually carried out under general anaesthetic, a small flexible tube is inserted into a vein at the top of your leg fine wires are guided to your heart. The responsible tissue is then destroyed to correct your heart rhythm.
• Implantable pacemaker: A pacemaker or defibrillator can correct or improve the rhythm of your heart. The device is passed through a vein in the leg while attached to a wire and guided into your heart. This is usually done under local anaesthetic and sedation.