Atrial Flutter
Einstein Health Glossary
ICD 10 - I48
What is atrial flutter?
Atrial flutter is the second most common sustained arrhythmia, second only to atrial fibrillation. In contrast to atrial fibrillation, flutter is an organized and regular arrhythmia that typically presents in a characteristic pattern on an electrocardiogram (ECG).
Causes
Atrial flutter can develop in patients with a structurally normal heart, but it occurs more frequently in older individuals with other associated conditions such as systemic arterial hypertension or heart failure. The association between atrial flutter and atrial fibrillation is common, and one arrhythmia may spontaneously convert into the other or be converted through medication.
Symptoms
Atrial flutter can be paroxysmal (with spontaneous onset and termination) or persistent (requiring cardioversion to stop), and it can present clinically in various ways—from asymptomatic patients to those with significant symptoms such as palpitations, chest pain, and shortness of breath. Dizziness and syncope (fainting) are rare. Atrial flutter is also associated with thromboembolic events (blood clots that dislodge from the heart), so patients with this arrhythmia should be evaluated for the need to receive anticoagulants (blood-thinning medications).
Diagnosis
Since atrial flutter often persists for extended periods, an electrocardiogram (ECG) performed during the arrhythmia episode is usually sufficient to establish the diagnosis. In some cases, additional tests may be necessary, such as a 24-hour to 7-day Holter monitor, an external event monitor, or an implantable event monitor, which can track heart rhythm for up to 3 years.
Treatment
The most effective way to reverse atrial flutter is through the application of an electric shock to the chest (electrical cardioversion). This procedure is performed with the patient sedated by an anesthesiologist. It is relatively simple and safe, and can even be done on an outpatient basis in individuals without associated conditions.
Treatment to control atrial flutter can also be done with medications or through catheter ablation using radiofrequency energy (cauterization), which is the preferred approach. The success of ablation depends on the type of atrial flutter and the presence of heart disease. However, the success rate for the more typical forms is quite high, and the procedure is curative in most cases.
Prevention
Controlling cardiovascular risk factors—such as high blood pressure, diabetes, sleep apnea, physical inactivity, and obesity—as well as treating heart conditions (e.g., heart failure), can help prevent atrial flutter.