Atrial flutter (AF) is defined as a category of irregular “heart rate” or arrhythmias. This happens when the heart’s upper chambers beat too rapidly. Also when the top chambers, heartbeats rapidly i.e. atria as compared to the lower chambers i.e. the ventricle. This affects the co-ordination of the heart rhythm. In other word, this condition results in tachycardia i.e. rapid beating of the heart and palpitations. This condition is very similar to Atrial Fibrillation (AF).

This category is electrographically depicted in the form of “flutter waves”, that are in a saw-tooth form of activation of the atria. The rate/speed at which the atria ranges are higher than 250 bpm and till 320 bpm.

The rate/speed at which the ventricle ranges is 120 to 160 bpm.

The beating of the heart is a sort of “electrical circuit.” A few times, the signal that originates it, goes wrong. As mentioned above, atrial flutter occurs from an improper circuit in the right-sided atrium or the “upper chamber of the heart.” A normal beat of the heart is 60 to 100 beats per minute (bpm). It beats very rapidly.

The beats of the heart go slow, once the signal arrives at the AV node, a group of cells that are situated in the “upper walls of the muscle” placed in the middle of the ventricles i.e. the lower chamber of the heart. The beating of the heart reduces to one-fourth or half.

When a heart beats at a very rapid rate it is termed as tachycardia. The origination of atrial flutter is from the atria, therefore it is termed as supraventricular (over-head) tachycardia.

Symptoms of Atrial Flutter

It is not always that a person suffering from atrial flutter feels the flutter sensation. Sometimes they display the symptoms in some other ways/manner. The symptoms are such as:

  • Rapid heart rate
  • Breathlessness
  • Fainting sensation or light-headedness
  • Chest gets tight or pressure feeling in the chest.
  • Heart Palpitations (there could be some sensations in the chest like heartbeat increases, fluttering feeling)
  • Anxiety
  • Due to tired feeling, not able to do everyday activities

If there is any sort of stress or depression, it increases the speed of heart rate and aggravates the symptoms for Atrial Flutter (AF). If suffering from these symptoms, not always means that it is an indication for Atrial Flutter (AF). The symptoms could occur for days or weeks, at one time.

Types of Atrial Flutter

  • Paroxysmal Atrial Flutter: This is not stagnant, it goes and comes. One episode of Atrial Flutter stays for hours or even days. This is somewhat temporarily.
  • Persistent Atrial Flutter: This is not temporary. It is somewhere going to last forever.

Causes of Atrial Flutter

The speed of the heart i.e. heart rate is controlled by a “natural pacemaker” i.e. Sinus Node. This is situated in the right atria. This forwards the electrical signals to the atria i.e. right and left. The signals inform the upper part of the heart related to the contraction i.e. how and when to contract.

When Atrial Flutter occurs, sinus node forwards the electrical signals in which some of the signals move in a constant way along the path throughout the right atria. This results in the atrial contraction fast, causing the atria to beat fast than the ventricles.

Various things can cause Atrial Fibrillation. These are:

  • Coronary Artery Disease (CAD): This condition is a result of arteries of the heart getting clogged due to plaque formation. In this condition, plaque is formed due to cholesterol and fats latching to the arterial wall. This decreases the flow of the blood. It can affect the muscles of the heart, chambers of the heart and blood vessels. One of the main/ chief factors of Atrial Flutter (AF) is Heart diseases/illness.
  • Open Heart Surgery: This causes a scar to the heart. This results in blocking of the “electrical signals” that leads to atrial flutter.
  • Ischemia: When the flow of blood to the heart decreases due to coronary heart disease (CAD), arteries get hardened or a clot in the blood.
  • High Blood Pressure
  • Cardiomyopathy: Heart muscle is affected.
  • Hypertrophy: The chamber of the heart is enlarged.
  • Heart Valves are abnormal: Majorly the mitral valve i.e. it helps maintain the flow of blood from the left atria (upper chamber of the heart) to the left ventricle (lower chamber of the heart).
  • Sometimes, the source of origin is unknown but atrial flutter can also occur due to a disease that is present anywhere else in the body but harming the heart. They are mentioned below:
  • Hyperthyroidism: Thyroid gland is extra-active and the metabolism is very high, the expenditure of energy is high.
  • Pulmonary Embolism: In the lungs, there is a clot in the vessels of the blood.
  • Chronic Obstructive Pulmonary Embolism (COPD): This is a disease in which the quantity of oxygen in the blood is decreased.

It could be certain products that modify the way your heart passes “electrical signals.”

Which individuals are at risk of suffering from atrial flutter?

  • People who smoke
  • Those who are suffering from heart ailments
  • Hypertension
  • Suffering from a heart attack
  • Lung disease/conditions
  • Any sort of stress/depression or eagerness
  • Individuals who are suffering from diabetes
  • Excess intake of alcohol
  • Medicines for dieting or losing weight
  • Individuals who have recently undergone a surgery

When to see a doctor?

When the symptoms for Atrial Flutter (AF) is observed.

If the medicines for Atrial Flutter (AF) is going on and the signs and symptoms for Atrial Flutter occur as mentioned.

If already the diagnosis and treatment for atrial fibrillation are on-going, things like chest pain, syncope or light-headedness or excess chest pain occur, instantly take the individual to a hospital in the emergency department.

Diagnosis (Examinations and Tests to be done)

Treatment cannot be started until and unless the doctor is aware of the type of arrhythmia/dysthymia. Atrial flutter (AF) will be diagnosed if the heartbeats go higher than 100 beats per minute (bpm). It is very important to know about the individual’s family history related to heart diseases, blood pressure, anxiety issues and more. The below-mentioned tests will help inform about what’s going on with an individual’s heart:

Electrocardiogram (EKG)

It helps in measuring and documenting, the electrical signal through which the heartbeat is controlled. If you can trace, it helps identify the arrhythmia type and from where in the heart it arises. EKG also depicts the signs and symptoms for heart attack, heart ischemia, problems in the conduction, Abnormality in the heart i.e. abnormal enlargement of the heart, issues with the chemicals in the body i.e. Potassium and Calcium in the tissue of your heart.

If none of the symptoms are visible, the doctor might ask you to conduct this test, if they observe any symptoms for atrial flutter.

Holter Monitor/ Ambulatory EKG

If any of the signs and symptoms for atrial flutter is observed, this particular test will be conducted, but the result will be a normal EKG result. This could result in arrhythmias coming and going or due to premature beats of the heart, which are not harmful.

This test helps detect if the individual has a specific arrhythmia and the type of the same. While doing the normal daily routine, this monitor is worn around the neck for some days. The EKG electrodes are further connected to the person’s chest. The heart rhythm is then recorded continuously for around 24-72 hours by this device.

Event Monitor

This needs to be worn for a long time, so, therefore, it is a small one.

When something irregular occurs, it can be started.

A few times, the physician can insert a recorder to record the event below the skin, that an individual can wear for various months or weeks.

Echocardiogram

This is a test that is safe and not like a painful ultrasound test. This makes an image of the inside of the heart using sound waves when beating and between the beats.

It finds out about the problem related to the heart valves, sees how good the ventricles are working and looks for clots of blood in the atria.

The technique used here is the same as that of checking the babies in the womb.

Treatment goals for atrial flutter

The goal is as mentioned below:

  • The rate of heart needs to be controlled.
  • To get back the normal sinus rhythm.
  • Avoid any episodes in the future.
  • To avoid stroke episodes also
Important to control the rate of ventricles.

If any life-threatening symptoms such as chest pain or congestive heart failure, the physician will give Intravenous medications or electrical shock known as cardio-version.

If the condition is not very serious or life-threatening then the medicines will be given orally by mouth.

A few times, a mix of oral drugs would be needed to control the rate/speed of the heart.

Very rarely, surgery might be needed to keep control of your heart rate and rhythm.

To get back the normal sinus rhythm

If an individual is diagnosed with atrial flutter recently or newly, the heart rhythm comes back to normal in 24-48 hours.

The main treatment is to change the atrial flutter to regular sinus rhythm and see to it, it does not happen again.

Everybody with atrial-flutter might not need anti-arrhythmic medicines.

Whether the arrhythmias return and the symptoms would occur, is partly regulates whether you will be getting the anti-arrhythmic drugs.

Prevent future episodes

To keep the beating of the heart at a safe and proper rate, it can be done by taking regular medicines.

Prevent stroke

Atrial flutter causes this shocking complication i.e. stroke. In this condition a part of a blood clot in the heart latches off from there and goes to the brain, affecting the flow of blood. Medical illness such as congestive heart failure and mitral valve disease increases the chances of stroke.

If you have a constant issue of atrial flutter, it is important to consume a blood-thinning agent to avoid clotting of the blood.

Treatment for Atrial Flutter

Two ways to treat Atrial flutter i.e. to get back a normal heart rate and sinus rhythm is by medication and defibrillation.

Electrical Cardioversion

In this condition, a shock is given to your heart by the physician to manage and monitor the heart-beat. In this condition, electrodes will be attached to the chest. Initially

Medicines would be given to fall asleep. Then the electrodes will be connected to your chest or sometimes at the back. This provides an electrical shock in a mild form to get back the normal heart rhythm. Normally the same day can go back home.

Radio-frequency ablation

This is a sort of catheter ablation majorly used for atrial flutter. The physician inserts a tube which is flexible in the blood vessel into your leg or neck, which is then directed to the heart. Once the tube reaches the area where the arrhythmias are occurring it gives out radio frequency energy that harms/damages the cells causing death. The tissue that is treated helps to get back the normal heartbeat again.

After this surgery, you might need a pacemaker to control the beat of the heart. With-out any ablation, a pace-maker may be used.

Medications

Medicines will help slow down or monitor an individual’s heart rate. For the body to adjust, some medicines might require to stay in the hospital for a short period. Some medicines could include calcium channel blockers, beta-blockers, and digoxin.

Some medications are used to change the atrial flutter to regular sinus rhythm. For example amiodarone, propafenone and flecainide are few of them.

Some are blood-thinners that help prevent the clotting of blood such as non-vitamin K oral anticoagulants (NOAC’s). Individuals with Atrial Flutter causes an increased chance of clotting of the blood.

Long –Term Expectations

Major of the time, medicines do help treat Atrial Flutter. This condition could again happen after the treatment is done depending on what causes Atrial Flutter. Recurrence can be avoided by avoiding stress and taking medicines on time.

References

  1. https://www.ncbi.nlm.nih.gov/pubmed/11445058
  2. https://www.ncbi.nlm.nih.gov/books/NBK540985/
  3. https://www.aerjournal.com/articles/atrial-flutter-typical-atypical
  4. https://www.tandfonline.com/doi/full/10.1080/20009666.2018.1514932
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