Atrial flutter

Atrial Flutter

Description, Causes and Risk Factors:

Abbreviation: AF.

Rapid regular atrial contractions occurring usually at rates between 250 and 330 per minute and often producing "saw-tooth" waves in the electrocardiogram, particularly leads II, III, and aVF.

Atrial flutter

AF is the most common sustained arrhythmia seen in clinical practice, affecting an estimated 4.5 million people in the European Union and 2.2 million Americans. AF is associated with a major risk of stroke, caused by a thrombus that forms within the left atrium and embolises to block a cerebral artery. The degree of stroke risk and the need for anticoagulant therapy to lower this risk varies among patients with AF.


    Type I atrial flutter: Rates between 250 and 330 per minute.

  • Type II atrial flutter: Rates of 330-450 per minute.

In AF, the atria are stimulated to contract very quickly and differently from the normal pattern. The impulses are sent to the ventricles in an irregular pattern. Some impulses fail to be transmitted. This makes the ventricles beat abnormally, leading to an irregular usually fast pulse. AF can affect both men and women. It becomes more common with increasing age.

AF can be caused by scarring in the heart resulting from prior cardiac disease or heart surgery, but it can also occur in some patients with no other identifiable heart problems. During AF, instead of the electrical activity starting in the SA node (sinus node), electrical activity begins in a large circuit that causes the atria to beat very rapidly. The rapid beating of the atria can in turn cause the ventricles to beat rapidly. AF typically originates from the right atrium (RA) and most often involves a large circuit that travels around the area of the tricuspid valve (TV) that is between the right atrium (RA) and the right ventricle (RV). This type of AF is referred to as typical atrial flutter. Less commonly, atrial flutter can result from circuits in other areas of the right or left atrium that cause the heart to beat fast. AF that results from these less common types of circuits is referred to as atypical atrial flutter.

Risk Factors include:

  • Age.

  • Heavy alcohol use.

  • High blood pressure (HBP).

  • Congestive heart failure.

  • Coronary artery disease.

  • Hypertrophic cardiomyopathy.

  • Hyperthyroidism.

  • Pericarditis.


    Dizziness, light-headedness.

  • Fainting.

  • Confusion.

  • Fatigue.

  • Pulse that feels rapid, racing, pounding, fluttering, or too slow.

  • Pulse that feels regular or irregular.

  • Sensation of feeling the heart beat (palpitations).

  • Sensation of tightness in the chest.

  • Shortness of breath.


The health care provider may hear a fast heartbeat while listening to the heart with a stethoscope. The pulse may feel rapid, irregular, or both. In AF the heart rate may be above 200.

To diagnose AF, your doctor may do tests that involve the following:

    BLOOD TESTS: These help your doctor rule out thyroid problems or other substances in your blood that may lead to atrial fibrillation.

  • HOLTER MONITOR (HM): This is a portable machine that records all of your heartbeats. You wear the monitor under your clothing. It records information about the electrical activity of your heart as you go about your normal activities for a day or two. You can press a button if you feel symptoms, so your doctor can know what heart rhythm was present at that moment.

  • ELECTROCARDIOGRAM (ECG or EKG): In this noninvasive test, patches with wires (electrodes) are attached to your skin to measure electrical impulses given off by your heart. Impulses are recorded as waves displayed on a monitor.

  • EVENT RECORDER: This device is similar to a Holter Monitor except that not all of your heartbeats are recorded. There are two recorder types: One uses a phone to transmit signals from the recorder while you're experiencing symptoms. The other type is worn all the time (except while showering) for as long as a month. Event recorders are especially useful in diagnosing rhythm disturbances that occur at unpredictable times.

  • ECHOCARDIOGRAM (also called as echo): In this noninvasive test, sound waves are used to produce a video image of your heart. Sound waves are directed at your heart from a wand-like device (transducer) that's held on your chest. The sound waves that bounce off your heart are reflected through your chest wall and processed electronically to provide video images of your heart in motion, to detect underlying structural heart disease.

  • CHEST X-RAY: X-ray images help your doctor see the condition of your lungs and heart. Your doctor can also use an X-ray to diagnose conditions other than atrial fibrillation that may explain your signs and symptoms.

  • CORONARY ANGIOGRAPHY (or) CORONARY ARTERIOGRAPHY. An X-ray examination of the blood vessels or chambers of the heart. A catheter is inserted into a blood vessel in your groin area or arm. The tip of the tube is positioned either in the heart or at the beginning of the arteries supplying the heart, and a special fluid (called a contrast medium or dye) is injected. This fluid is visible by X-ray, and the pictures that are obtained are called angiograms.

  • Electrophysiologic study (EPS).

  • Exercise treadmill ECG.


The treatment of AF involves treating the fast heart rate, reducing the risk of stroke, and converting to or maintaining normal sinus rhythm. Medications often are used to slow the fast heart beat. Some medications that may be used for rate control include beta-blockers, calcium channel blockers, and digoxin. In addition, some antiarrhythmic drugs may also have the added benefit of slowing the fast heart rate. If you have AF and additional risk factors for stroke, your cardiologist may decide to prescribe a blood thinner to reduce your risk of stroke.

Surgical options include:

    Electrical Cardioversion.

  • Catheter ablation.

Disclaimer:The above information is general information. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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