Atrial Flutter

Atrial Flutter is due to the fast irregular rhythm in the atria which mainly occurs when the electrical signals that control muscle contractions in the upper chambers (atria) of the heart become rapid sometimes causing the heart to beat at a rate greater than 300 beats per minute. It is a very fast beating of the atria (the upper two chambers of the heart). Atrial Flutter is a rhythmic, fast rhythm that occurs in the atria of the heart. This rhythm occurs most often in individuals with organic heart disease (ie: pericarditis, coronary artery disease, and cardiomyopathy). That is a rapid well-organized contraction of the atrium at a rate of 250-350 contractions per minute. Ventricular beats are usually some multiple of 300. ECG shows saw tooth waves.

Atrial flutter is considered a serious and potentially unstable rhythm. This is a single "short circuit" in the atria that causes the atria to beat at about 300 beats per minute while the lower chambers of the heart (the ventricles) beat at a slower rate (often 75 or 150 beats per minute). A type of supraventricular tachycardia. Atrial flutter occurs when an abnormal conduction circuit develops inside the right atrium, allowing the atria to beat excessively fast, about 250-300 beats per minute. Atrial flutter commonly occurs in the setting of acute myocardial infarction, after pneumonectomy and after cardiac surgery in adults. It is unusual in children.

Causes of Atrial Flutter

Some common causes of Atrial flutter:

• In many people, there is no apparent cause for AF. These individuals have what is called "lone" or idiopathic Atrial flutter.
• AF may be related to other medical conditions, such as: coronary artery disease (CAD), thyroid disease, high blood pressure (hypertension), structural defects of the heart and its valves, lung disease and other medical conditions.
• Patients at highest risk include those with long-standing hypertension, valvular heart disease (rheumatic), left ventricular hypertrophy, coronary artery disease with or without depressed left ventricular function, pericarditis, pulmonary embolism, hyperthyroidism, and diabetes. Additionally, CHF for any reason is a noted contributor to this disorder.
• Atrial flutter can be the result of valve disease, hardening of the arteries, thyroid disease, or heart failure.
• Another cause is swelling and irritation of the outside of the heart.
• Arrhythmias are caused by a disruption of the normal functioning of the electrical conduction system of the heart. Normally, the atria and ventricles contract in a coordinated manner.
• The condition can be caused by impulses which are transmitted to the ventricles in an irregular fashion or by some impulses failing to be transmitted.
• This makes the ventricles beat irregularly, which leads to an irregular (and usually fast) pulse in atrial fibrillation.

Signs and symptoms of Atrial flutter

Signs and symptoms often experienced with atrial flutter are similar to those of atrial fibrillation, such as

• a pounding heart rate or pulse,
• hortness of breath
• dizziness
• Pulse may feel regular or irregular
• Dizziness, light-headedness
• Fainting
• Confusion
• Fatigue
• Shortness of breath
• Breathing difficulty, lying down

Atrial flutter Treatment

Atrial fibrillation may require emergency treatment to convert the arrhythmia to normal (sinus) rhythm, either with electrical cardioversion or with the administration of intravenous drugs, such as dofetilide or ibutilide. For most patients with atrial flutter, radiofrequency ablation is the current treatment of choice.

Atrial flutter commonly occurs in the setting of acute myocardial infarction, after pneumonectomy and after cardiac surgery in adults. It is unusual in children. Some effective treatment methods of Atrial Flutter:

• Atrial fibrillation may require emergency treatment to convert the arrhythmia to normal (sinus) rhythm. This treatment may involve either with electrical cardioversion or intravenous (IV) drugs such as dofetilide, amiodarone, or ibutilide.
• Prehospital Care: In general, avoiding class I and III agents (eg, procainamide) in the prehospital setting is safest because of possible induction of 1:1 conduction. Generally, the rate can be slowed safely with calcium channel blockers or beta-adrenergic blockers.
• Long-term treatment varies depending on the cause of the atrial fibrillation or flutter. Medication may include beta-blockers, calcium channel blockers, digitalis or other medications (such as anti-arrhythmic drugs), which slow the heartbeat or the conduction of the impulse from the atria to the ventricles
• Ablation of the AV junction leads to complete heart block. Treatment for this condition requires a permanent pacemaker .
• Blood thinners, such as heparin or Coumadin, may be given to reduce the risk of a thromboembolic event such as a stroke.
• attempt to restore and maintain the sinus rhythm, or regular rhythm of the heart through electrical cardioversion
• slow the heart rate, using medications or catheter radiofrequency ablation
• reduce the risk of stroke with medications

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