Atrial flutter definition and facts
- Atrial flutter is a condition where the
atria of the heart rapidly and regularly beat due to an anomaly in the heart's
electrical system that usually results in a tachycardia.
- It produces feelings like
near-fainting, rapid heartbeats (palpitations), mild shortness of breath, and
- This type of arrhythmia can be
dangerous because complications can easily develop.
- Atrial fibrillation lasts for
variable periods ranging from intermittent short time periods to constant rapid
- Atrial flutter and atrial fibrillation (AFib)
are closely related. Flutter produces regular tachycardia while fibrillation
produces irregular tachycardia.
- Certain triggers may cause the
arrhythmia; however, the triggers result in a reentry loop that causes the
heart's electrical system to produce rapid, regular atrial contractions.
- Risks for getting this heart condition
include a number of medical problems and poor personal habits such as an
unhealthy eating habits and drinking too much alcohol.
- Atrial flutter is not the same as a
stroke or a heart attack.
- Although there are many tests to
evaluate the atrial fibrillation, the most common diagnostic test is an electrocardiogram
- Antidysrhythmics, beta-blockers, and
anticoagulants are the three general types of drugs used to treat and manage
this type of heart disease.
- Medical procedures to treat and manage flutter
may include Valsalva procedures, cardioversion, cardiac ablation and medication
for the prevention of clot formation.
- Doctors that treat the disease may
include primary care physicians, emergency medicine, cardiologists and
- Your risk of developing atrial flutter
can be reduced by avoiding drinking excessive alcohol, eating a
and appropriate care of any medical condition.
- The prognosis for patients with atrial
flutter that get ablation treatment is excellent. Those who have additional
medical problems and respond to treatments poorly have a worse prognosis and
likely a shorter lifespan.
What is atrial flutter (ECG)?
Atrial flutter is a health condition (arrhythmia) where the atria of the heart as an electrical problem (a re-entry loop) that causes the atria to beat at a rapid rate of about 242 - 360 beats per minute (bpm). It is the second most common tachyarrhythmia, with atrial fibrillation (AFib) being the most common. Although usually flutter waves are regular and appear as "sawtooth" P waves in ECG's (typical atrial flutter); occasionally electrical conduction blocks can occur and produce 2:1, 3:1 or 4:1 waves or even appear as irregular bpm's resembling an irregular arrhythmia. Infrequently, atrial flutter may be seen with bradycardia (an abnormal heart rhythm that is slow) when the heart ventricles do not receive most of the atrial flutter P waves and thus do not mimic the atrial rate.
ECG Strip (Electrocardiogram, EKG) of Sawtooth Pattern of Atrial Flutter
What does atrial flutter feel like (symptoms)?
Although a few people have no symptoms, common clinical symptoms of this arrhythmia are as follows:
- Palpitations (feeling of heart beating or pounding)
- Shortness of breath (usually mild)
- Pre-syncope (feeling like you going to faint)
- Blurry vision
Less common but more serious symptoms of this flutter arrhythmia include chest pain, more severe shortness of breath, and fainting. These symptoms suggest that your health is being compromised.
Quick GuideAtrial Fibrillation: Heart Symptoms, Diagnosis, & Afib Treatment
Is It Atrial Flutter or Atrial Fibrillation? How to Tell the Difference!
Atrial flutter and atrial fibrillation (AFib) are both a type of atrial tachycardia. Atrial tachycardia is a type of abnormal heart rhythm. Both diseases have common symptoms like shortness of breath, palpitations, and fatigue.
One of the distinctions between these two heart diseases are their ECG (electrocardiogram, EKG) wave patterns. Atrial flutter produces a sawtooth pattern with tracings of P waves on the ECG, and AFib produces irregular QRS waves without discernible P waves.
Is atrial flutter dangerous?
Atrial flutter arrhythmias can be dangerous to your health because of the
complications that they can lead to. Some of the complications of typical and
atypical atrial flutter include the following:
- Tachycardia or rapid heartbeat (blood
may not be pumped adequately resulting in decreased function or failure of
various organs, especially the brain and heart muscle)
- Low blood pressure (hypotension)
- Chronic atrial fibrillation
How long does atrial flutter last?
Atrial flutter or atrial fibrillation lasts for variable times. In some
people, it can convert to normal sinus rhythm often within a week or so, or it
can continue constantly for weeks or months. Some patients may have
flutter waves that last less than a day, spontaneously terminate, but return
irregularly and are termed paroxysmal atrial flutter. Unfortunately, atrial
flutter also can convert to another abnormal heart rhythm such as atrial
fibrillation over the same time periods.
Atrial flutter vs. atrial fibrillation (AFib)
The main difference between atrial flutter and atrial fibrillation (AFib) is
that in atrial flutter, the rapid heartbeat is regular while in atrial
fibrillation the heartbeat is irregular. However, the other symptoms mentioned
above are very similar. In addition, diagnosis and treatment procedures also are
similar if not exactly the same. For example, the treatment guidelines for
atrial fibrillation and atrial flutter by the
American Heart Association are the same.
What causes atrial flutter?
Although no one knows for sure what triggers or causes atrial flutter, it is
likely from the risk factors listed in the next section. In individuals with
these risk factors, some injury probably
occurs to alter the healthy electrical pacemaker in the heart atrium that allows
a reentry loop for electrical signals to follow. The sinus node sends out an
electric signal, but travels along the continuous loop in atrial flutter causing
the atria of the heart to contract rapidly, usually with the atria contracting
faster than the ventricles although some individuals with the heart disease can
have about a 1:1 conduction that results in a heartbeat of about 250 – 300 bpm.
Who gets atrial flutter (risks)?
There are many risk factors for this type of flutter. The following is a list
of some of the more common risk factors:
Are atrial flutter, stroke, and heart attack the same?
Atrial flutter is not the same as a stroke or heart attack. It is an abnormal
heartbeat that usually is regular and faster than normal. Although it and atrial
fibrillation can lead to a stroke or heart attack, it is neither. A stroke is
defined as a sudden disabling attack or loss of consciousness caused by an
interruption in the flow of blood to the brain. A heart attack is a sudden and
sometimes fatal occurrence usually due to coronary thrombosis, resulting in
death of part of the heart's muscle.
How do the ECG wave strip patterns of atrial flutter differ from a normal ECG?
Differences bewteen ECG wave strip patterns
To diagnosis this type of arrhythmia the doctor or health care professional will ask you about your medical history, history of symptoms, and physical exam. Electrocardiography (ECG or EKG) frequently makes the diagnosis by showing saw tooth flutter waves in several (II, III, aVF and/or V1) of the 12 ECG leads recorded, indicating atrial tachycardia of about 250 – 350 bpm.
Atrial flutter ECG sawtooth wave strip pattern
ECG Sawtooth Wave Strip Pattern of Atrial Flutter
Normal ECG wave pattern
Normal ECG Wave Strip Pattern
Other tests to diagnose atrial flutter
Other tests that are useful to diagnose this tachycardia when flutter waves are obscured by the ventricular tachycardia. These tests and medical devices include vagal maneuvers, administration of IV adenosine and, when the flutter waves come and go intermittently. Holter monitor may be used to identify the arrhythmia.
Other studies may be done to help evaluate a patient's atrial flutter. For example, transesophageal electrocardiography can evaluate the heart for presence of thrombus and transthoracic electrocardiography can image the internal parts of the heart using ultrasound. In addition, your doctor or other health care professional may order additional tests for underlying problems that may trigger symptoms.
Medications to treat and manage atrial flutter
There are three types of drugs used to treat atrial flutter.
Antidysrhythmics: slows or interferes with the electric signals that produce atrial flutter; examples are:
Beta-Blockers: slow the heart's ventricular response to atrial signals by slowing the AV nodal conduction; examples are:
Anticoagulants: used to prevent thromboembolic complications (blood clots); examples are:
The choices of medication(s) to use is based on your medical condition. These medications should be discussed with your doctor or other health care professional before you take them.
What procedures treat and manage atrial flutter?
The procedures used for the treatment and management atrial flutter are varied; however, the
goals are similar – restoration of sinus rhythm, control of ventricular rate
prevention of recurrent episodes, prevention of thrombus formation – all with
minimizing adverse effects from therapy. In patients that are stable, vagal
maneuvers such as holding your breath and bearing down (like having a bowel
movement) may be effective. Other procedures may need to be considered depending
on individual patient's situation. For example, immediate electrical
cardioversion is used for patients that have severe symptoms and are considered
to be unstable. For patients that are stable but still have episodes of atrial
flutter, radiofrequency ablation of the circular path way in the heart can be
done as an elective procedure. Other procedures or heart abnormalities may cause
a few patients to need a pacemaker to control the heart rate.
Although some patients may recover completely and remain in a sinus rhythm,
others may require additional therapy to prevent thromboembolic (blood clots)
complications with anticoagulant medication.
Which specialties of doctors treat atrial flutter?
Although primary care physicians can treat a few individuals with
uncomplicated atrial flutter, specialists usually are involved in patient care.
Emergency medicine specialists and cardiologists are the main specialists that
see and treat this type of arrhythmia. In addition, some cardiologists
specialize in diagnosis and treatment of the electrical activity of the heart,
they are cardiac electrophysiologists.
How can atrial flutter be prevented?
Atrial flutter can be prevented or the risk of it decreased by reducing the
factors that may trigger it. The simplest things to do to prevent it are:
If you have underlying health conditions such as lung disease or diabetes,
for example, appropriate treatment of these conditions will help decrease the
risk or prevent atrial flutter. The ablation procedure may prevent subsequent
occurrences of an abnormal heart rhythm like atrial fibrillation and an atrial rate seen in
atrial flutter and restore relatively normal electrical heart health.
What is the prognosis and life expectancy for a person with atrial flutter?
The prognosis and life expectancy for a person with atrial flutter depends on
the patient's underlying condition. Those with complicated medical conditions
and respond poorly to drugs or procedures have a reduced prognosis. However,
patients that undergo successful ablation have an excellent prognosis. Although
there is little or no data available on life expectancy with atrial flutter,
data from the well-known Framingham heart study suggests that patients with
atrial fibrillation, which is closely related to atrial flutter, have a shorter
lifespan than normal control individuals although how much shorter is not clear.
For more clinical information and patient resources, see the Heat Rhythm Society at www.hrsonline.org/.
Medically Reviewed on 3/28/2017
Borke, J. MD. "Emergent Management of Atrial Flutter." Mesdape: Updated: Feb 07, 2017.
Heart Rhythm Society.
Rosenthal, L., MD. "Atrial Flutter Treatment and Management." Updated: Dec 30, 2015.