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Atrial Flutter

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Atrial Flutter


Atrial flutter (AFL) is a common abnormal heart rhythm, that similar to atrial fibrillation, is a supraventricular (ie. above the ventricles) tachycardia (rapid heart beats).   In AFL, the upper chambers (atria) of the heart beat fast, resulting in atrial muscle contractions that are out of sync and faster than the lower chambers (ventricles).


atrail flutter image


What is Atrial Flutter?
The heart’s electrical system is the power source that makes the heart beat properly.   Electrical impulses travel along a specific pathway to make the upper and lower chambers of the heart (atria and the ventricles) work together to pump blood through the heart’s four chambers.

A normal heartbeat begins as a single electrical impulse that originates in the sinoatrial (SA) node, a small bundle of conducting tissue located in the right atrium.   The impulse then emits an electrical pulse that causes the atria to contract and force blood into the lower ventricles.   Next, the electrical current passes through the atrioventricular (AV) node (the electrical conduit between the upper and lower heart chambers), causing the ventricles to squeeze and release in a rhythmic, steady sequence.   As the chambers contract and relax, they pull blood into the heart and force it back out to the body.   This pressure is what we feel when we check for our pulse in our wrist or neck.


With AF however, the electrical signal travels along a pathway solely within the right atrium.   It moves in a circular organized motion, or “circuit,” causing the atria to beat a lot faster than the ventricles.   The fast, but regular pattern of AFL is what makes it different from AFib.   AFL makes a very distinct “sawtooth” pattern on a test used to diagnose abnormal heart rhythms, the electrocardiogram (ECG).


Risk Factors for Atrial Flutter


There are several medical complications that can increase the risk for developing AFL such as:


  • Previous heart attack
  • High blood pressure
  • Thyroid dysfunction
  • Chronic lung disease
  • Diabetes
  • Heart failure
  • Congenital defects or valve abnormalities
  • Recent surgery
  • Alcoholism (especially binge drinking)
  • Acute (serious) illness


Symptoms of Atrial Flutter


Because, the electrical signal that causes AFL circulates in a predictable, organized pattern people with AFL usually continue to have a steady, faster than normal  heartbeat.   It is possible that people with AFL may not feel symptoms.   Others do experience symptoms such as:


  • Fast, steady pulse
  • Trouble with activities or everyday exercises
  • Fainting, dizziness, or lightheadedness
  • Heart palpitations (feeling like your heart is fluttering/pounding or racing)
  • Shortness of breath
  • Discomfort in your chest, pain, tightness or pressure.



Questions to ask your doctor: 


  • How can I be assured that I have AFL and not a more serious heart rhythm problem?
  • What are the risks that the AFL will become worse (ie. more symptomatic)?
  • What are my treatment options?
  • What are the benefits & risks of other treatment options?
  • What is the cause of my AFL?
  • Will my condition resolve by itself?
  • Do I have an increased risk of having a stroke?
  • What are the side effects and risks of medications to control my AFL, and/or to reduce the risk of stroke?
  • Should I see an electrophysiologist?



Complications of Atrial Flutter


AFL alone isn’t life threatening; however, if left untreated, the side effects of AFL can be life threatening.   It’s harder for the heart to pump blood effectively and since the blood moves more slowly, it is more likely to form clots.   If the clot is then pumped out of the heart, it could go to the brain and lead to a stroke or heart attack.

Without treatment, AFL causes a fast pulse rate for long periods of time which means the ventricles are beating too fast for long periods of time.   The heart muscle can then become weak, a condition known as cardiomyopathy, that can lead to heart failure and long-term disability.   Without treatment, AFL can also induce another type of arrhythmia called atrial fibrillation.

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