Causes and Risk Factors
Atrial flutter becomes more common with age and with conditions that stretch or scar the atria:- Heart and lung disease: High blood pressure, coronary artery disease, valve disease, heart failure, and chronic lung disease all increase risk.
- Prior heart surgery or ablation: Scar tissue in the atria can create the short circuit that sustains flutter.
- Overactive thyroid: Excess thyroid hormone speeds and irritates the heart; see hyperthyroidism.
- Sleep apnea, alcohol, and stimulants: Untreated sleep apnea, heavy drinking, and stimulant use can trigger episodes.
- Diabetes and obesity: Both conditions strain the heart over time and are associated with more frequent atrial rhythm problems.
Symptoms
Some people feel nothing and the rhythm is found on a routine examination. Because the lower chambers often lock in at every second impulse, some people notice their heart rate seems stuck at the same fast number — often near 150 — whenever symptoms strike. When symptoms occur, they may include:- Palpitations: A rapid, often strikingly regular pounding or fluttering in the chest.
- Fatigue and reduced stamina: The heart pumps less efficiently at high rates, so exertion feels harder.
- Shortness of breath or chest discomfort: Especially with activity.
- Lightheadedness: Occasionally with near-fainting if the rate is very fast.
Diagnosis
An electrocardiogram usually makes the diagnosis, showing a characteristic "sawtooth" pattern of atrial activity. Because episodes can come and go, your physician may order a wearable heart monitor, along with an echocardiogram to assess the heart's structure and blood tests to check thyroid function. Blood tests also screen for anemia and electrolyte problems that can aggravate rapid rhythms. Atrial flutter is one of several rapid rhythms arising above the ventricles, a group that also includes supraventricular tachycardia.Treatment
Treatment has three goals — control the rate, restore normal rhythm, and prevent stroke. Your physician weighs how long the rhythm has been present, how fast it is, and your individual risk profile when choosing among these options:- Rate control: Beta-blockers such as metoprolol or calcium channel blockers such as diltiazem slow conduction to the lower chambers; digoxin is occasionally added.
- Stroke prevention: Like atrial fibrillation, flutter allows blood to pool and clot in the atria, so blood thinners such as apixaban or rivaroxaban are prescribed based on individual stroke risk.
- Cardioversion: A brief, controlled electrical shock delivered under sedation can restore normal rhythm.
- Catheter ablation: For typical atrial flutter, ablation interrupts the circuit with a very high success rate and is often recommended as a definitive treatment.