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Atrial Flutter

Condition

Atrial flutter is a common abnormal heart rhythm where the upper chambers (atria) of the heart are beating too fast.

What is Atrial Flutter?

These fast atrial heart muscle contractions are out of sync with the lower chambers (ventricles) and can be dangerous if left untreated. Unlike atrial fibrillation which is an irregular heart rhythm, the atria in atrial flutter usually beat in a rapid regular manner.

 

The electrical system of the heart is responsible for making the heartbeat. Electrical impulses travel along a pathway in the heart and make the upper and lower chambers of the heart work together to pump blood. 

In atrial flutter, the electrical signal travels along a pathway within the right atrium. It moves in an organized circular motion, or "circuit," causing the atria to beat faster than the ventricles. Heart-atria are electrically isolated (like a rubber mat between them) towards the heart-ventricles. The ventricles receive their signals via a small gap, the atrio-ventricular (AV) node.

 

This node is responsible for delaying the signal to instruct the ventricular beat and  to allow a split second of delay time for the blood to travel between the upper atria to the  lower ventricle chambers of the heart before they contract and throw the blood out in the body vessels like a sophisticated pump. 

In atrial flutter, the AV node will receive more signals than usual from the atria and in most cases will allow (filter) a certain number through, often seen in a ratio of 1 in 2, 1 in 3 or 1 in 4 patterns.

 

This maintains a degree of control and regularity in the ventricular rate but resulting in a faster or very fast heart rate.

 

What are the symptoms and risks of Atrial Flutter?

Patients with atrial flutter usually continue to have a regular heartbeat, even though it is faster than normal. It is possible that patients may feel no symptoms at all. Others do experience symptoms, which may include: heart palpitations, shortness of breath and fatigue, a reduced exercise tolerance, pressure, tightness or discomfort in your chest and dizziness, lightheadedness, or fainting. 

If left untreated, the side effects of atrial flutter can, in selected individuals, lead to more serious conditions. There is a risk of stroke due to clot formation or heart failure due to the heart beating rapidly for long periods of time causing the heart muscle to become weak. This can cause  shortness of breath, pulmonary edema and leg swelling (=edema).

 

What assessment do I need if I have Atrial Flutter?

If the Cardiologist suspects atrial flutter, then a simple ECG may already confirm the diagnosis. In case it is coming and going  (paroxysmal) making the diagnosis becomes more difficult and will require longer periods of ECG monitoring with ambulatory ECG monitoring devices (a heart monitor which is worn for 1 or more days, ECG recording devices like Kardiva AliveCor -Medtronic, medical wearable devices like the Apple Watch, fit bit and other modern recording gadgets). Under the skin (subcutaneous) implantable small event-recorders / loop-recorders from Medtronic (link reveal) or Biotronik (Biomonitor III) are further important options to detect paroxysmal arrhythmias. 

An echocardiography, referred to as an 'echo', is performed  to evaluate the structure and function of the heart in some detail, which may reveal a structural cause of the atrial fibrillation, like heart chamber dilatation or valvular disease . In many patients, additional tests like blood analysis will also be required to identify the underlying cause. 

One of the most important aspects of your assessment will be to evaluate your individual risk for a stroke to determine whether you will benefit from blood thinning medication (anticoagulants). Your cardiologist will be able to discuss this in detail with you.

 

 

What are the treatments for Atrial Flutter?

Although drugs that regulate heart rate and rhythm can be used in an attempt to control atrial flutter, this type of heart rhythm is particularly resistant to medications. Cardioversion is an alternative option where an electrical current is used to "shock" the heart back to its normal rhythm.

The optimal recommended treatment is  radiofrequency catheter ablation  in a distinct area of the right atrial heart chamber which is an  almost 99% curative treatment for atrial flutter and is therefore associated with better success rates and much lower recurrence rates when compared to medication or cardioversion.

 

What intervention/treatment does CardioCare offer for Atrial Flutter?

Our EP-lab is well equipped with the newest technology from companies like BIOTRONIK, MEDTRONIC, ABBOTT, BOSTON SCIENTIFIC and others to perform electric cardioversions and radiofrequency catheter ablation therapy.

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