Atrial Flutter


Normal Heart Rhythm.

In order for the heart to do its work (pumping blood throughout the body), it needs a sort of spark plug or electrical impulse to generate a heartbeat. Normally, this electrical impulse begins in the upper right chamber of the heart (in the right atrium) in a place called the sino-atrial (SA) node. The SA node is the natural pacemaker of the heart. The SA node gives off electrical impulses to generate a heartbeat in the range of 60 to 100 times per minute.

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How do abnormal heart rhythms occur?

In some hearts, an abnormal heart rhythm develops when an electrical impulse either starts from a different location, other than the SA node, or follows a route (or pathway) that is not normally present. This is what happens in atrial flutter. A short-circuit develops in the right atrium as show in the diagram below.

  • The internal structure of a heart.
  • The internal structure of a heart shows the SA node.
  • The internal structure of a heart shows the AV node.
  • The image shows Atrial Flutter due to a short circuit in one of the upper chambers of the heart, the right atrium.
  • Atrial Flutter with ECG reading.
  • Atrial Flutter with ECG reading showing the ineffective pumping of the upper chambers.
  • Atrial Flutter with ECG reading showing the pumping of the lower chambers.
  • Atrial Flutter with ECG reading showing the expansion of the lower chambers.

Atrial Flutter is due to a short circuit in one of the upper chambers of your heart, termed the right atrium. This rapid short circuit has several consequences:

  1. The short circuit drives the pumping chambers very rapidly and sometimes erratically. This produces palpitations, shortness of breath, and tiredness. In some people it can also cause dizziness and chest pain.
  2. The short circuit results in ineffective pumping of the upper chambers. This leads to slow blood flow in both of these upper chambers (the left and right atrium). This can rarely cause blood clots and possibly stroke. One of the major reasons to cure atrial flutter is to prevent this risk of stroke.


What treatments are available for atrial flutter?

  1. Medications: Atrial flutter can be treated with medication. In some people these medicines can be very effective. In others however, the medications are ineffective and may produce side effects. If you elect to take medication, your doctor will discuss the different options and the possible side effects of these medications.
  2. DC Shock: When the heart is in flutter, it can be reverted to the normal rhythm with a “shock on the chest”. You receive a short general anaesthetic and the shock reverts the rhythm to normal in almost all cases. With this approach, the possibility of the flutter returning remains present (approximately 50% of patients will have another episode of atrial flutter over the next year). In addition, most patients will also require a medicine to try to prevent the flutter coming back.
  3. Blood Thinning medication:  Because of the risk that atrial flutter may return with the above treatments, most patients with atrial flutter will require blood thinning medication to prevent blood clots forming. At your doctor's discretion, this may either be with aspirin or warfarin.
  4. Radiofrequency ablation:  This procedure carries a success rate of approximately 95% for curing the atrial flutter. The risk of the flutter returning at some time in the future is approximately 10%.

-Senior Consultant Cardiologist & Electrophysiologist

-Chief, Cardiac Pacing and Arrhythmia Services

-Department of Cardiac Pacing and Electrophysiology

-Apollo Hospitals, Greams Road, Chennai.

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