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What Is Atrial Flutter?

When your electrical system is working normally, the two upper chambers of the heart (atria) contract and pump blood into the two lower chambers (ventricles) in a well-coordinated way. This results in a normal resting heart rate of 60 to 100 beats per minute. 

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 than 100 beats per minute, it is called a rapid ventricular response (RVR). An episode of RVR can last minutes, hours, or days.

University of Utah Health cardiologists provide expert care for patients with atrial flutter, including diagnostic testing and minimally invasive treatment options. Our highly trained cardiologists will develop a treatment plan that’s right for you.

Atrial Flutter vs. Atrial Fibrillation (AFib)

Atrial flutter is similar to another type of arrhythmia called atrial fibrillation (AFib). Both start in the upper chambers of the heart and cause a fast heartbeat and increase your risk of stroke. But in AFib, the heartbeat is often more irregular and chaotic.

Atrial fibrillation is more common than atrial flutter. An estimated 40 percent of people with atrial flutter also have AFib.

Types of Atrial Flutter

There are two types of atrial flutter: typical and atypical. 

  • Typical atrial flutter is more common and usually responds better to treatment. The short-circuit is located in the right upper heart chamber around the heart’s tricuspid valve, which separates the atria and ventricle.
  • Atypical atrial flutter is caused by scarring on the left side of the heart from prior heart surgeries, previous procedures, or heart disease. The scarring can stretch and injure the upper heart chamber, leading to problems such as heart failure or valvular heart disease. During an RVR, the heart can beat 100-200 times a minute.

Both of these conditions can lead to a rapid ventricular response (RVR), causing the heart to beat 100-200 times a minute.

Risk Factors for Atrial Flutter

Atrial flutter is much more common in people over the age of 50, and your risk increases with age. It can occur due to diseases or other problems in the heart or by a disease somewhere else in your body that affects your heart.

You may be at higher risk for atrial flutter if you have: 

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.

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Atrial Flutter Symptoms

The most common symptom of atrial flutter is a fast yet steady heartbeat. This symptom can be constant, or it can come and go. During a rapid ventricular response (RVR), other symptoms may include:

  • anxiety,
  • shortness of breath,
  • palpitations (fluttering in the chest), and
  • fatigue.

About 30 percent of people with atrial flutter do not experience any symptoms. These individuals are typically diagnosed with atrial flutter when they are being evaluated for another health problem, such as heart failure or stroke.

Is Atrial Flutter Dangerous?

Atrial flutter is not life-threatening. But it can cause serious side effects, including:

With treatment, people with atrial flutter usually experience significant improvement in their symptoms and avoid serious side effects of the condition.

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:

  • you will lie down on an examining table or bed.
  • a provider will stick 12 sensors to your chest and limbs. These sensors have wires that connect to a monitor.
  • the sensors will record the electrical signals that make your heartbeat.
  • a computer will record the electrical activity and display it as waves on the computer screen or a print-out.

If your irregular heartbeat comes and goes, a standard EKG might not be enough to diagnose your condition. In that case, the doctor may recommend wearing a portable EKG monitor for a period of time.

The doctor may also recommend an ultrasound test to make sure the heart muscle is still healthy.

Atrial Flutter Treatment

Sometimes atrial flutter goes away by itself. If not, your doctor may recommend treatment. Our heart specialists have extensive experience in treating people with atrial flutter and AFib. We will develop a detailed treatment plan for you, which may include one or more of the therapies below.

Cardiac Ablation

During a cardiac ablation, we will insert thin, flexible tubes into your groin and guide them to the affected area. This procedure uses heat energy or cold energy to destroy a small area of heart tissue that is causing the atrial flutter. You will be sedated for this procedure. But it is unlikely you will need general anesthesia requiring the use of a ventilator.

Cardiac ablation is very effective for people with typical atrial flutter, providing a cure for 90 percent of these patients. With atypical atrial flutter, cardiac ablation is successful for 60 to 70 percent of patients, since additional scarring in the heart chamber may develop over time and cause different atypical atrial flutters. 

Other Treatments

Other treatment options for atrial flutter include:

  • medication to control your heart rhythm. Medication alone is successful in 20 to 30 percent of people with atrial flutter.
  • electrical cardioversion therapy, which involves using a special machine to send electrical energy to the heart muscle. This commonly will restore your normal heart rhythm. But over time, atrial flutter often returns since cardioversion alone does not correct the underlying causes of an abnormal heart rhythm.

Atrial Flutter Prognosis

Most people with atrial flutter experience an improvement in symptoms after treatment. However, some symptoms may continue, even after treatment. If that happens, our cardiologists will continue to work with you to minimize your symptoms and help you experience the best quality of life possible.

You can take steps to reduce your symptoms of atrial flutter. Your doctor may recommend:

  • exercising 30-60 minutes a day;
  • limiting your intake of alcohol and stimulants such as caffeine;
  • losing weight, if you are overweight; or
  • blood thinners to lower your risk of stroke.

Make an Appointment with Our Cardiologists

Referrals are welcome but not necessary when making an appointment with a cardiologist at U of U Health. To make an appointment, call 801-585-7676. Our team will verify your insurance coverage before your visit. If you have had medical tests related to your condition, we will request the results from your provider. Our goal is to make your visit as efficient and helpful as possible.

Hear From Our Patients

In his late 20s, Parker Donat was an active guy known for his dedicated gym routine. By age 33, he was struggling to keep up with his wife Kristi during hikes—even when she had their small son strapped to her chest. Parker couldn't figure out why he was always "dogging it."

In addition to feeling worn out all the time, the young dad had another strange symptom: It often felt like his heart was beating in his throat. It was so bad, he'd get light-headed and he had trouble swallowing. It wasn't until he felt like he couldn't breathe and went to University of Utah Health's clinic in Farmington that he began to understand what was going on.

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