Atrial Flutter (Atrial Flutters)

Atrial flutter34[1]

Atrial flutter is a condition, characterized by abnormal heart rhythm that occurs in the atria of the heart. Such a type of condition is associated with a heart rate of 240 to 400 beats per minutes, a phenomenon known as tachycardia.


Not every individual with atrial flutter will have symptoms. The reason is that healthy individuals can very well tolerate the increase in heart rate; however those with underlying disease conditions can experience pain in the chest, dyspnea, nausea, nervousness, and dizziness. In more severe cases, or when the flutter continues for longer duration, then it can lead to heart failure, or development of nocturnal breathlessness and edema of the legs and abdomen [6].

Patients suffering from atrial flutter have also reported to experience the following symptoms:

  • Anxiety
  • Tremor-like feeling in the heart accompanied by discomfort in the chest
  • Difficulty in carrying out everyday exercise or routine activities
  • Palpitations 
  • Fainting 


A preliminary physical examination will be done, followed by the following diagnostic procedures:

  • Electrocardiogram [7] 
  • Holter monitor: This is a device for continuous recording of the heart beat for 24 to 72 hours.
  • Echocardiogram: This is done to evaluate the shape, size as well as motion of the heart. In addition, transthoracic echocardiography is also a preferred mode for evaluating atrial flutter.
  • Electrophysiological study: This would help in identifying the exact location of the abnormal rhythm. Such a type of method would also help in treating the condition.


The basic objective of treatment is to reduce the electrical impulses, which would in turn help in normalizing the heart beat. In order to achieve this, the following methods would be employed [8]:

  • Medications: Various medications such as beta blockers, adenosine, digoxin and calcium channel antagonists, are administered for treating atrial flutter. In addition, antiarrhythmics would also be required, to treat the condition. These include propafenone, amiodarone, ibutilide, sotalol, flecainide and dofetilide.
  • Debrillation: In this method, defibrillation is applied externally, to bring back the heart beat to normal. This method is also known as cardioversion [9].
  • Ablation therapy: This is the treatment of choice, and is employed when medications do not work, and individuals experience repeated bouts of atrial flutter. Such a therapy is carried out during the electrophysiological study; wherein the area from where abnormal heart rhythm arises is destroyed with the help of the same catheters [10].
  • Anticoagulation: This is important for preventing recurrent bouts of atrial flutter and also help onset of complications from setting in.


When appropriately treated, atrial flutter can be successfully managed, and seldom gives rise to any complications. However, without treatment, it can lead to development of stroke and blood clots [5]. Underlying medical conditions gravely affect the prognosis of atrial flutter. Patients with Wolff-Parkinson-White syndrome, who also suffer from atrial flutter, are at risk of developing life threatening consequences, if catheter ablation is not considered in such cases. Also, untreated atrial flutter can lead to atrial fibrillation, cardiomyopathy and long term disability.


Individuals living with heart disease, or those who have undergone open heart surgery, are at an increased risk of developing atrial flutter. Stress and anxiety can also considerably increase the risk of the condition. Certain medications prescribed for cold, overuse of caffeine, diet pills and alcohol, predispose an individual to develop atrial flutter [2].

In addition to the above mentioned conditions, there are various risk factors that significantly increase the chances of atrial flutter. These include:


The condition of atrial flutter majorly affects the population of older adults. About 200,000 new cases of atrial flutter are known to occur in the US every year [3]. Men are at an increased risk of developing the condition. In a study of 100 patients suffering from atrial flutter, it was seen that 75% of them were males.

Sex distribution
Age distribution


Factors that interfere with the appropriate functioning of the electrical impulses of the heart, may give rise to the condition of atrial flutter. Under normal conditions, the sinus node controls the heart, which is situated on the top of the atrium. In this condition, the atria send out reentrant rhythms that overwhelm the sinus node. Such a phenomenon causes the atria to contract rapidly [4].


The following steps can be taken for preventing attacks of atrial flutter:

  • Decrease the consumption of caffeine, alcohol, nicotine and stimulants.
  • Prompt treatment for underlying heart ailments.
  • Significantly decrease the stress and anxiety levels.


This condition was described and identified as an independent medical condition by British physician Sir Thomas Lewis in the year 1920. Atrial flutter is grouped into the category of supraventricular tachycardia. In this condition, the atria of heart beat so fast, that the muscle contractions of the atria are faster than those of ventricles. Atrial flutter is associated with certain degree of atrioventricular node conduction block [1].

Patient Information

  • Definition: Atrial flutter is characterized by abnormal heart rhythms, which arise from the atrial chamber of the heart. It is a rare condition as compared to atrial fibrillation. Males are at an increased risk of contracting this condition than females.
  • Cause: Underlying heart disease, stress, anxiety and open heart surgery, predisposes an individual to develop atrial flutter. In addition, caffeine, stimulants, nicotine, alcohol and smoking, also considerably increase the chances of developing atrial flutter.
  • Symptoms: Symptoms of atrial flutter include fast paced heart beat, dizziness, lightheadedness, anxiety, shortness of breath and discomfort in the chest. Individuals also complain of tremor-like feeling in the heart.
  • Diagnosis: Atrial flutter is diagnosed using the electrocardiogram, echocardiogram, holter monitor and electrophysiological study.
  • Treatment: The major goal of treating atrial flutter includes bringing back the abnormal heart beat to normal, and prevention of future attacks. Medications, cardioversion, ablation therapy, and blood thinners are employed for treating attacks of atrial flutter.


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  1. Garson A Jr, Bink-Boelkens M, Hesslein PS, et al. Atrial flutter in the young: a collaborative study of 380 cases. J Am Coll Cardiol 1985; 6:871.
  2. Ghali WA, Wasil BI, Brant R, Exner DV, Cornuz J. Atrial flutter and the risk of thromboembolism: a systematic review and meta-analysis. Am J Med. Feb 2005;118(2):101-7.
  3. Granada J, Uribe W, Chyou PH, et al. Incidence and predictors of atrial flutter in the general population. J Am Coll Cardiol 2000; 36:2242.
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  9. Crijns HJ, Van Gelder IC, Tieleman RG, et al. Long-term outcome of electrical cardioversion in patients with chronic atrial flutter. Heart 1997; 77:56.
  10. Coffey JO, d'Avila A, Dukkipati S, Danik SB, Gangireddy SR, Koruth JS, et al. Catheter ablation of scar-related atypical atrial flutter. Europace. Mar 2013;15(3):414-9.

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