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atrial flutter

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Electrocardiogram showing atrial flutter (rapid heart beat)

Alternative Names
auricular flutter

Atrial flutter is a very rapid, regular heart beat that starts in the atria, or upper chambers of the heart.

What is going on in the body?
In a person with atrial flutter, the regular beating of the atria is replaced by a rapid beating, known as atrial flutter. During these episodes the heart can beat 250 to 350 beats per minute. The condition is caused by a short circuit in the electrical system of one atrium. This short circuit starts the heart beating much more rapidly than normal. Only some of the beats get through, so the entire heart doesn't usually beat as fast as the atria.

What are the signs and symptoms of the condition?
Symptoms of atrial flutter vary greatly, depending upon the person's heart and lung condition. They can include: What are the causes and risks of the condition?
Atrial flutter is caused by a short circuit in one atrium. The electrical system starts running out of control, forcing the heart to beat rapidly. Atrial flutter most often comes after a heart attack or open-heart surgery.

Atrial flutter is seen more often in people: What can be done to prevent the condition?
Some medications can reduce the episodes of atrial flutter. Atrial flutter can also be prevented by a surgical procedure that gets rid of the short circuit.

How is the condition diagnosed?
A doctor diagnoses atrial flutter by examining the person and feeling his or her pulse. The doctor also listens to the heart through a stethoscope, checking for the abnormal heartbeats. Since other arrhythmias, or irregular heartbeats, can lead to a fast pulse, the actual diagnosis is confirmed with an electrocardiogram, or ECG.

A more specialised test, known as an electrophysiology study, can also be performed to locate the short circuit in the heart's electrical system. This test involves placing a catheter, or thin tube, through the skin and into an artery in the groin. The catheter is then advanced into the heart to map its electrical activity.

What are the long-term effects of the condition?
Atrial flutter affects the way the heart pumps blood. It can lead to or worsen congestive heart failure. Elderly individuals and people who already have heart disease are most likely to develop congestive heart failure. The extra work caused by atrial flutter may lead to chest pain and even heart attack in people with coronary artery disease.

What are the risks to others?
Atrial flutter is not contagious, and does not put other people at risk.

What are the treatments for the condition?
Treatment depends on the cause of the atrial flutter. In some individuals, the main goal of treatment is to control the heart rate. This is especially true for those who have congestive heart failure, chest pain, or hyperthyroidism.

Medications that can slow or control the fast heart rate include:
  • beta blockers, such as metoprolol, atenolol and sotalol.
  • calcium channel blockers, such as verapamil or diltiazem
  • digoxin
Medications that may prevent episodes of atrial flutter include flecainide and amiodarone.

Episodes of atrial flutter can be stopped by delivering a small electrical shock to the heart, a procedure known as a cardioversion. This shock can be delivered by a pacemaker or through the skin with a defibrillator set to a lower power.

Future episodes of atrial flutter can be prevented by destroying the short circuit in the atrium. This can be done by surgery or with sound waves.

What are the side effects of the treatments?
Side effects to some of the medications can include a slow heart rate or low blood pressure. A person with asthma or emphysema may not be able to tolerate beta-blockers because of their effect on the lungs. Some of the medications used to control atrial flutter can lead to worse arrhythmias. Any surgery can be complicated by bleeding, infection, or even death.

How is the condition monitored?
Atrial flutter is monitored by regular visits to the doctor and electrocardiograms, or ECGs. Blood tests are taken to ensure that medications are being given in the right amount.

Author: Bill Harrison, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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