Atrial Flutter: ECG, Symptoms, and Treatments

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).

• Atrial flutter is a condition where the atria of theheartrapidly 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), mildshortness of breath, andfatigue.
• This type ofarrhythmiacan be dangerous because complications can easily develop.
• Atrial fibrillationlasts for variable periods ranging from intermittent short time periods to constant rapid heartbeats.
• Atrial flutter andatrial fibrillation(AFib) are closely related. Flutter produces regular tachycardia whilefibrillationproduces irregular tachycardia.
• 特定的触发可能会导致心律失常;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 muchalcohol.
• Atrial flutter is not the same as astrokeor aheart attack.
• Although there are many tests to evaluate atrial flutter, the most common diagnostic test is anelectrocardiogram(ECG/EKG).
• Antiarrhythmics,beta-blockers, andanticoagulantsare the three general types ofdrugsused to treat and manage this type ofheart disease.
• Medical procedures to treat and manage flutter may include Valsalva procedures,cardioversion, cardiac ablation, and medication for thepreventionof clot formation.
• Your risk of developing atrial flutter can be reduced by avoiding drinking excessive alcohol, eating a healthydiet, 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.

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, withatrial fibrillation(AFib) being the most common. Although usually flutter waves are regular and appear as "sawtooth" P waves inECG'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

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 includechest pain, more severe shortness of breath, andfainting. These symptoms suggest that your health is being compromised.

The main difference between atrial flutter andatrial fibrillation(AFib) is that in atrial flutter, the rapid heartbeat is regular while inatrial fibrillationthe 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.

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 electricalpacemakerin the heartatriumthat 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 theheart diseasecan have about a 1:1 conduction that results in a heartbeat of about 250 – 300 bpm.

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

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.

Atrial flutter is not the same as astrokeorheart attack. It is an abnormal heartbeat that usually is regular and faster than normal. Although it and atrial fibrillation can lead to astrokeor heart attack, it is neither. Astrokeis defined as a sudden disabling attack orloss of consciousnesscaused 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.

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

• High blood pressure
• Obesity
• Diabetes
• 心failure
• Ischemicheart diseaseand/or a previous heart attack
• Serious acute illnesses
• Heavy alcohol intake and/or binge drinking
• Advanced age
• Hyperthyroidism
• Chronic lung disease
• Recent surgery
• Congenitalheart disease

Differences between ECG wave strip patterns

Atrial flutter is diagnosed by you medical history, history of symptoms, and a physical exam. Electrocardiography (ECG orEKG) 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

其他测试是有用的诊断这个速cardia 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 usingultrasound. In addition, your doctor or other health care professional may order additional tests for underlying problems that may trigger symptoms.

There are three types ofdrugsused to treat atrial flutter.

Antiarrhythmics:slows or interferes with the electric signals that produce atrial flutter; examples are:

• propafenone(Rythmol)
• flecainide(Tambocor)
• amiodarone(Cordarone)
• dronedarone (Multaq)
• sotalol(Betapace)
• dofetilide(Tikosyn)
• diltiazem(Cardizem)
• verapamil(Calan)
• digoxin(Lanoxin)

Beta-Blockers:slow the heart's ventricular response to atrial signals by slowing the AV nodal conduction; examples are:

• metoprolol(Lopressor)
• esmolol (Brevibloc)
• atenolol(Tenormin)

Anticoagulants:used to prevent thromboembolic complications (blood clots); examples are:

• warfarin(Coumadin,Jantoven)
• heparin
• dabigatran (Pradaxa)
• apixaban(Eliquis)
• rivaroxaban(Xarelto)

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.

用于治疗和管理的过程nt 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 electricalcardioversionis used for patients who have severe symptoms and are unstable. For patients that are stable but still have episodes of atrial flutter,radiofrequency ablationof 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 withanticoagulantmedication.

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 regularexerciseand be active
• Eat a heart healthydiet
• Avoid drinking too much alcohol and/orcaffeine.
• Don't smoke
• Maintain a healthy weight

If you have underlying health conditions such as lung disease ordiabetes, 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.

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/.

Although primary care physicians can treat a few individuals with uncomplicated atrial flutter, specialists usually are involved in patient care.Emergency medicinespecialists 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.