Atrial Flutter Treatment in London, UK | AF Causes

WHAT IS ATRIAL FLUTTER?

ATRIAL FLUTTER CAUSES

SIGNS AND SYMPTOMS OF ATRIAL FLUTTER

DIAGNOSTIC INVESTIGATIONS OF ATRIAL FLUTTER

ATRIAL FLUTTER TREATMENT

ATRIAL FLUTTER FAQs

What is Atrial Flutter?

Atrial flutter occurs when the electrical impulses from a circuit on top of the right atria (upper chambers of the heart), cause it to beat much more rapidly than normally at approximately 300 beats per minute (bpm) instead of the normal 60-90 bpm. The impulses from the top chamber do not quite conduct in a 1:1 manner to the ventricles (pumping chambers at the bottom of the heart), which typically conduct at 150 or 100 bpm, giving you this fixed increased pulse rate.

Thus, the atrial (filling chambers at the top) and ventricles (pumping chambers at the bottom) beat at different speeds, reducing the efficiency of the heart pump, and increasing the risk of stroke, owing to the pooling of blood and potential formation of clots within the atrial chambers, and the atrial appendage. If the blood clot breaks off and lodges in an artery supplying the brain, then a stroke occurs.

Note that there is a similarity in Atrial Flutter and Atrial Fibrillation (AF), and both of these can coexist in patients, as the risk factors are similar for both.

However, unlike AF, atrial flutter is due to a single abnormal short circuit in the right atria (upper chamber).

Another distinction is that your heart beats unusually fast albeit in a regular pattern. When read in a 12-lead electrocardiogram (ECG), a diagnostic test that checks your heart rhythm, a “sawtooth” pattern is seen which allows a clear diagnosis to be made. Fortunately, atrial flutter is almost always curable by a catheter ablation procedure with >95% success rates.

This is a single lead electrocardiogram (ECG) showing typical atrial flutter with the sawtooth pattern, a common arrhythmia which gives high heart rates and palpitations.

Atrial Flutter Causes

Underlying heart problems are usually the cause of atrial flutter. They are:

Cardiomyopathy – typically leads to enlargement of the atria
Congenital heart disease
Coronary artery disease
Previous cardiac surgery (including a valve or bypass surgery)
Heart valve disease
Hypertension
Lung disease, including chronic obstructive airways disease (COPD), obstructive sleep apnoea (OSA) and pulmonary hypertension
Myocarditis (heart inflammation)

Signs and Symptoms of Atrial Flutter

When you have Atrial Flutter, you may experience the following:

A steady and fast pulse rate
Chest discomfort (heaviness, tightness, and pain)
Difficulty in everyday activities and during exercise
Episodes of fainting
Feelings of lightheadedness or dizziness
Palpitations (heart is quivering and beating fast)
Fatigue
Shortness of breath

However, some patients with atrial flutter may not experience signs and symptoms.

Diagnostic Investigations of Atrial Flutter

Your doctor may order diagnostic tests to confirm a diagnosis of atrial flutter.

Electrocardiogram (ECG): With the use of electrodes, the ECG records the electrical patterns of the heart. Your doctor will check if the sawtooth pattern is recorded on the ECG strip.

Echocardiograms use sound waves to show how blood flows inside the heart and its vessels. This will help identify blood clots and assess heart valve problems and ventricular function.

Blood tests: To help rule out abnormal blood count, elements in your blood or thyroid problems, and heart failure. that may lead to AF.

Chest X-ray: Your doctor may order can also use a chest X-ray to diagnose conditions other than atrial fibrillation that may explain your signs and symptoms.

Holter monitor: This is a portable ECG device worn on a shoulder strap or belt, which monitors your heart’s activity for between 24 and 72 hours.

Sleep apnoea screening: This is a wrist device that can be fitted easily and you can wear it overnight. This screening test will be able to accurately diagnose sleep apnoea, which is a significant emerging risk factor for atrial flutter and AF.

Atrial Flutter Treatment

Atrial flutter treatment depends on a lot of factors and including the symptoms you experience and how long you’ve had it and the underlying cause or triggers of atrial flutter. According to the Atrial Flutter Doctor, primary treatment is given below.

HOW IS ATRIAL FLUTTER PERFORMED

The primary atrial flutter treatment goals are:

A. To decrease your risk of stroke

B. To reset your heart rate and rhythm

A. Decreasing stroke risk:

Atrial flutter may put you at risk of developing blood clots in your heart. If these blood clots become dislodged from the heart and pumped into the blood vessels in the brain, you may suffer from a stroke. Your risk of stroke is determined by risk factors such as:

Congestive Heart Failure

Hypertension

Age (>65yo)

Diabetes

Stroke, or previous transient ischaemic attack (TIA or mini-strokes which fully resolve)

Vascular Disease (such as previous heart attack, peripheral vascular disease)

Sex (Female above 65yo)

These risk factors may be summarized as the CHA2DS2VASc, and your doctors will ask you all these questions above when assessing whether you should be started on anticoagulant drugs

Preventing blood clots by using anticoagulants

Your doctor may prescribe anticoagulants or blood-thinning medications. They are:

Warfarin (Coumadin) is the oldest drug to avoid blood clots. Regular blood monitoring to check levels (INR – International Normalised Ratio) is advised to keep the levels well-controlled.
Apixaban (Eliquis), Dabigatran (Pradaxa), Rivaroxaban (Xarelto), and Edoxaban (Lixiana) are termed Direct Oral Anticoagulants (DOAC) and are agents of which have been introduced to replace warfarin as good alternatives. The immediate advantage of these is that they can be prescribed without the need for continuous lifelong monitoring, although they have similar effectiveness and bleeding risks as warfarin. This means that your doctors may offer you these agents as a useful alternative to warfarin.

Aspirin, which is an antiplatelet drug, is no longer routinely recommended to prevent strokes in AF as a sole agent. It may have a role, in combination with an anticoagulant drug, in patients who have had a past history of heart attacks or coronary artery stenting, but please be guided by your cardiologist on this. Other antiplatelet drugs include clopidogrel and ticagrelor. Always check with your cardiologist before stopping any of these antiplatelet drugs.

B. Resetting your heart’s rate and rhythm

This is done through electrical cardioversion, a method used to reset to normal heart rate and regular (sinus) rhythm. Cardioversion may be offered when an immediate and urgent “fix” is necessary to restore normal rhythm. This procedure is usually performed under a short general anaesthetic. Once asleep, an electrical shock is delivered to your heart through patches placed on your chest. The shock stops your heart’s beat momentarily before normal rhythm (termed sinus rhythm) starts again. However, this is unlikely to provide a permanent cure to flutter as the circuit continues to exist and it is a likely (>50%) chance at flutter will recur at some stage.

Controlling your heart rate:

Your doctor may prescribe medications to control your heart rate, aiming for a heart rate below 100bpm. These include the following:

Digoxin
Beta-blockers
Calcium channel blockers

Catheter ablation (keyhole surgery through the groin)

This procedure is the treatment of choice for atrial flutter, providing a >95% cure rate.

In this procedure, your doctor will insert thin catheters (electrical wires) through tubes in your groin all the way to your blood vessels and heart. Using electrical navigation (3D mapping systems or X-ray), your doctor will be able to position these catheters precisely to cauterise (radiofrequency energy) the weak link in the circuit, which is likely to cure you of atrial flutter permanently.

The procedure typically takes under an hour and can be performed safely under local anaesthesia, or general anaesthesia.

Complications of ablation

Complications from catheter ablation are rare, but include:

Groin haematoma (bruising), 4%
Pericardial effusion (a small collection of fluid around the heart), 2%
Pericardial tamponade (due to perforation in the heart), which may necessitate a drain insertion into the chest wall), 1%
Life-threatening complications (need for open-heart surgery, stroke, heart attack) <0.5%

Permanent pacemaker insertion

Rarely your doctor will recommend that you have a pacemaker inserted in atrial flutter. This is not a treatment which will “cure” atrial flutter, but rather, prevent slow heart rates due to progressive disease in the conducting tissue within the heart, which leads to slow heart rates in atrial flutter. Typically, this is recommended if your heart rate is under 50bpm, and particularly if you are not taking any other medications which may slow the heart rate (such as beta-blockers, digoxin or amiodarone).

Dr Boon Lim (best cardiologist London, UK) will be able to provide a thorough assessment through state-of-the-art diagnostic tests and provide a comprehensive treatment plan, including catheter ablation.

Contact Dr Lim now to arrange an appointment.

Atrial Flutter FAQs

How serious is atrial flutter?

Atrial Flutter is the second most common heart rhythm abnormality, after atrial fibrillation. It tends to occur in patients over 60 years of age, often with the coexisting disease of the heart’s valves or the lungs. Atrial flutter, like atrial fibrillation, can lead to various symptoms including shortness of breath, palpitations and dizziness. Being in atrial flutter may increase your risk of stroke, which is one of the most serious complications of any heart rhythm abnormality.

Atrial flutter on its own, without symptoms and without any risk factors for stroke, maybe tolerated for several months or years. However, if you have a pre-existing illness such as heart failure or significant lung problems, like severe chronic obstructive pulmonary disease, then being in flutter could abruptly lead to a significant worsening in breathing. If this is the case, please seek urgent medical attention. Read more…

What is the difference between atrial flutter and atrial fibrillation?

Atrial flutter and atrial fibrillation are both heart rhythm abnormalities, and both these rhythm abnormalities can cause symptoms of palpitations, shortness of breath and lightheadedness.

Atrial flutter is a regular rhythm that is due to a fixed distance “short circuit” within the right atrial chamber giving an atrial rate of 300 beats per minute (bpm). This typically gives a heart rate which is directly divisible by 300: for example 150bpm, 100bpm, 75bpm, 60bpm, 50bpm. This heart rate profile in such cases normally looks like a straight line – ie with a single heart rate, often at 150bpm throughout the daytime, and perhaps a little slower at 100bpm or 75pm at night, appearing in “steps”.

In atrial fibrillation, the abnormal circuits are seen within the left atrium. There are multiple circuits with varying cycles within the left atrium, which leads to a characteristic irregularly irregular heart rhythm profile, where heart rates vary immensely from beat to beat. The pulse feels erratic in both the rhythm as well as the strength of each heartbeat, with ranges typically from 90 to 180bpm.
Both heart rhythm abnormalities increase your risk of stroke, and the risk factors for stroke should be considered to guide you on whether you should be taking anticoagulation to prevent a stroke.

Can dehydration cause atrial flutter?

Dehydration is a form of stress, and given that most heart rhythm abnormalities are triggered by stress, dehydration can contribute to the development of atrial flutter. However, the most common triggers for atrial flutter are an infection (particularly lung infection) or post-cardiac surgery. Patients with chronic lung disease, such as chronic obstructive pulmonary disease (COPD) are also more susceptible to developing atrial flutter.

Will atrial flutter show up on ECG?

Atrial flutter can be clearly diagnosed on a 12 lead ECG with a characteristic sawtooth appearance.

Which is worse: Atrial flutter or atrial fibrillation?

Both rhythms can cause symptoms equally, and your tolerance of the heart rhythm abnormality will usually be dependent on co-existing medical conditions, such as heart failure or COPD.

However, in my experience, atrial flutter which is not controlled adequately with drugs isn’t tolerated as well, as the heart rates can often “sit” at 150bpm over the whole day – this is much to fast for the heart and may cause the heart to become fatigued and tired, leading to heart failure symptoms with impairment in heart contractility. Heart failure symptoms may also occur in atrial fibrillation, but because the circuit is not fixed, the heart typically has a “break” from high heart rates, particularly when resting where heart rates come closer to 90-100bpm, compared with the 150-180bpm seen during modest exertion in AF.

Both rhythms should be taken seriously, and the most important consideration is that both may lead to a stroke – thus stroke assessment using the CHADSVASC scoring system is important. Please discuss this with your doctor.

Is atrial flutter considered heart disease?

Atrial flutter is a form of heart rhythm abnormality and therefore can be considered a form of heart disease. Often this occurs with co-existing predisposing factors such as valvular heart disease, or lung disease such as COPD.

How long does an episode of atrial flutter last?

There are 2 forms of atrial flutter. The first is flutter which comes and goes intermittently, and the medical term to describe this is paroxysmal atrial flutter. In these cases, after atrial flutter is triggered, it’s possible that it may last from several minutes to several days.

The second form of atrial flutter, the heart rhythm abnormality persists continuously until medical treatment is given to stop flutter. This form of atrial flutter is termed persistent atrial flutter. Typically, treatments include drugs, cardioversion or ablation. The ablation option provides the possibility of a permanent cure for atrial flutter, with a >95% success rate)

Can drinking alcohol cause atrial flutter?

Yes, it can – alcohol can be considered stress, and this stress can trigger a bout of atrial flutter.

Will stopping alcohol stop Atrial flutter?

If atrial flutter is commonly triggered and sustained by having alcohol, then yes, stopping or significantly cutting back on alcohol should reduce recurrent episodes of atrial flutter.

Can you hear atrial flutter with stethoscope?

You cannot actually “listen” for an atrial flutter on the stethoscope. You can pick up the heart rate and rhythm by feeling and listening to the pulse and may be able to discern atrial fibrillation. However, a persistently elevated and fixed heart rate (say at 150bpm) which does not shift after sitting relaxed for several minutes, gives an indication that there may be a heart rhythm abnormality. In this case, proceeding to have a 12 lead electrocardiogram (ECG) will usually make a very clear diagnosis.

Is atrial flutter hereditary?

No.

Is it safe to exercise with atrial flutter?

This depends – if your heart rate is already starting off at 150bpm, then it may not be wise to do too much exertion in atrial flutter. Instead please see your doctor urgently, as atrial flutter is usually easily treated curatively (95% success rate) with an ablation procedure.