Atrial Flutter Symptoms, Causes, ECG, and Treatments

  • Medical Author:
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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 fatigue.
  • 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 heartbeats.
  • 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 atrial flutter, the most common diagnostic test is an electrocardiogram (ECG/EKG).
  • Antiarrhythmics, 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.
  • Your risk of developing atrial flutter can be reduced by avoiding drinking excessive alcohol, eating a healthy diet, 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.
  • Doctors that treat the disease may include primary care physicians, emergency medicine, cardiologists, and electrophysiologists.

Quick GuideAtrial Fibrillation: Heart Symptoms, Diagnosis, & Afib Treatment

Atrial 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.

What is atrial flutter? What does an atrial flutter ECG (EKG) look like?

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 (Electrocardiogram, EKG) of Sawtooth ECG Pattern of Atrial Flutter
ECG Strip (Electrocardiogram, EKG) of Sawtooth Pattern of Atrial Flutter

What are the signs and symptoms of atrial flutter? What does it feel like?

Although a few people have no symptoms, common clinical symptoms of this arrhythmia are as follows:

  1. Palpitations (feeling of heart beating or pounding)
  2. Fatigue
  3. Shortness of breath (usually mild)
  4. Pre-syncope (feeling like you going to faint)
  5. Lightheadedness
  6. 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.

Atrial flutter vs. atrial fibrillation (AFib), which is worse?

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. Moreover, diagnosis and treatment procedures also are similar if not exactly the same. For example, 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.

Is atrial flutter a serious arrhythmia?

Atrial flutter arrhythmias can be dangerous to your health because of complications caused by the heart condition. Some typical and atypical atrial flutter complications include:

  • 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)
  • Thromboembolism
  • Stroke
  • Cardiomyopathy
  • 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 during the same period.

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.

What are the risk factors for atrial flutter?

There are many risk factors for this type of flutter. The following is a list of some of the more common risk factors:

Atrial flutter ECG wave strip patterns vs. normal ECG used in diagnosis

Differences between ECG wave strip patterns

Atrial flutter is diagnosed by you medical history, history of symptoms, and a 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 Wave Patterns of the Sawtooth Pattern of Atrial Flutter

ECG Sawtooth Wave Strip Pattern of Atrial Flutter

Normal ECG wave pattern

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.

Antiarrhythmics: 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.

Quick GuideAtrial Fibrillation: Heart Symptoms, Diagnosis, & Afib Treatment

Atrial Fibrillation: Heart Symptoms, Diagnosis, & Afib Treatment

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 who have severe symptoms and are unstable. For patients that are stable but still have episodes of atrial flutter, radiofrequency ablation of the circular pathway 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.

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:

  • Get regular exercise and be active
  • Eat a heart healthy diet
  • Avoid drinking too much alcohol and/or caffeine.
  • Don't smoke
  • Maintain a healthy weight

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 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/.

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. Cardiac electrophysiologists specialize in diagnosis and treatment of the electrical activity of the heart.

Quick GuideAtrial Fibrillation: Heart Symptoms, Diagnosis, & Afib Treatment

Atrial Fibrillation: Heart Symptoms, Diagnosis, & Afib Treatment

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Medically Reviewed on 3/27/2018
References
REFERENCES:

Borke, J. MD. "Emergent Management of Atrial Flutter." Mesdape: Updated: Feb 07, 2017.
<http://emedicine.medscape.com/article/757549-overview>

Heart Rhythm Society.
<www.hrsonline.org/>

Rosenthal, L., MD. "Atrial Flutter Treatment and Management." Updated: Nov 17, 2017.
<http://emedicine.medscape.com/article/151210-treatment#>

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