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Atrial Flutter

Atrial flutter is a rapid, organized heart rhythm from the upper chambers that causes palpitations, fatigue, and shortness of breath and raises stroke risk much like atrial fibrillation.

Cardiovascular
Atrial flutter is an abnormal heart rhythm in which an electrical circuit races around the upper chambers of the heart (the atria), driving them to beat around 250 to 350 times per minute. The lower chambers usually respond to every second or third impulse, so the pulse is often rapid but regular — classically near 150 beats per minute. Atrial flutter is closely related to atrial fibrillation, and many people experience both rhythms at different times. Although flutter is the less common of the two, untreated it carries many of the same risks and is managed in much the same way. 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.
When to Seek Immediate Care: Call 911 for chest pain, fainting, severe shortness of breath, or any signs of stroke such as sudden weakness on one side, facial drooping, or trouble speaking. Because untreated atrial flutter can silently raise stroke risk and tire the heart, timely evaluation matters. The internal-medicine team at Zimmer Medical Group can detect the rhythm, start protective treatment, and coordinate care with an electrophysiologist when ablation is appropriate.

Related Medications

Commonly prescribed medications for this condition

MetoprololDiltiazemDigoxinApixabanRivaroxaban

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