Difference between atrial flutter and atrial fibrillation

Atrial flutter is a problem with the way your heart beats. Such problems, whether in the rhythm or speed of the heartbeat, are known as arrhythmias.

What Happens in Atrial Flutter?

Your heartbeat is a sort of electrical circuit. Sometimes the signals cause it to go awry. Atrial flutter results from an abnormal circuit inside the right atrium, or upper chamber of your heart. It beats extra fast, about 250-400 beats per minute. A normal heartbeat is 60-100 beats per minute.

The beat slows down when the signals reach the AV node, a bundle of cells in the upper wall of muscle between the ventricles, your heart’s lower chambers. It usually slows the beats by a fourth or a half, or down to somewhere between 150 and 75 beats per minute.

An abnormally fast heart rate is called tachycardia. Because atrial flutter comes from the atria, it is called a supraventricular (above the ventricles) tachycardia.

What Are the Risks of Atrial Flutter?

The main danger with atrial flutter is that your heart doesn’t pump blood very well when it beats too fast.

• Vital organs like the heart muscle and brain may not get enough blood, which can cause them to fail.
• Congestive heart failure, heart attack, and stroke can result.

With proper treatment, atrial flutter is rarely life-threatening. Complications of atrial flutter can be devastating, but treatment almost always prevents them.

Are There Types of Atrial Flutter?

Paroxysmal atrial flutter can come and go. An episode of atrial flutter usually lasts hours or days.

Persistent atrial flutter is more or less permanent.

Who Gets Atrial Flutter?

You're more likely to get this condition if you've had:

• Heart failure
• A heart attack
• High blood pressure
• Heart valve problems
• Long-term lung disease
• Diabetes
• Thyroid disease
• Alcohol abuse
• Another serious illness

What Causes Atrial Flutter?

Doctors don’t always know. In some people, no root cause is ever found. But atrial flutter can result from:

• Diseases or other problems in the heart
• A disease elsewhere in your body that affects the heart
• Substances that change the way your heart transmits electrical impulses

Heart diseases or problems that can cause atrial flutter include:

• Ischemia: Lower blood flow to the heart due to coronary heart disease, hardening of the arteries, or a blood clot
• Hypertension: High blood pressure
• Cardiomyopathy: Disease of the heart muscle
• Abnormal heart valves: Especially the mitral valve
• Hypertrophy: An enlarged chamber of the heart
• Open-heart surgery

Diseases elsewhere in your body that affect the heart include:

• Hyperthyroidism: An overactive thyroid gland
• Pulmonary embolism: A blood clot in a blood vessel in the lungs
• Chronic obstructive pulmonary disease(COPD): A condition that lowers the amount of oxygen in your blood

Substances that may contribute to atrial flutter include:

• Alcohol (wine, beer, or hard liquor)
• Stimulants like cocaine, amphetamines, diet pills, cold medicines, and even caffeine

What Is the Difference Between Atrial Flutter and Atrial Fibrillation (AFib)?

Atrial flutter is closely related to AFib, another arrhythmia. Symptoms like a racing heart and dizziness are common with both conditions. About one-third of people who have AFib also have atrial flutter.

In atrial flutter, electrical impulses don't travel in a straight line from the top of your heart to the bottom. Instead, they move in a circle inside the upper chambers. As a result, your heart beats too fast, but still in a steady rhythm.

In AFib, the electrical signals that travel through the atria are fast and disorderly, which makes them quiver instead of squeezing strongly. This causes the heart to beat too fast and in a chaotic rhythm.

Atrial Flutter Symptoms

Some people have no symptoms at all with atrial flutter. Others describe:

• Palpitations (rapid heartbeat or a pounding or fluttering sensation in the chest)
• Shortness of breath
• Anxiety
• Trouble exercising
• Confusion
• Tiredness

People with heart or lung disease who have atrial flutter may have these and other, more significant symptoms:

• Angina pectoris (chest or heart pains)
• Feeling faint or lightheaded
• Fainting

When to Seek Medical Care for Atrial Flutter

Call your doctor:

• If you have any of the symptoms of atrial flutter
• If you’re taking medication for atrial flutter and you have any of the signs and symptoms described
• If you've been diagnosed and are being treated for atrial flutter, go immediately to a hospital emergency department if you:
  • Have severe chest pain
  • Feel faint or lightheaded
  • Faint

Atrial Flutter Exams and Tests

When you tell them your symptoms, your doctor will probably suspect an arrhythmia. Because other conditions can cause similar symptoms, the doctor will want to rule out the most dangerous ones. Also, you can’t get treatment until the doctor knows your specific arrhythmia type. These tests can tell a lot about what’s happening with your heart:

Electrocardiogram(EKG)

• Your medical team places small patches on your chest to measure and record the electrical impulses that control your heartbeat.
• The EKG highlights problems in these impulses and abnormalities in the heart.
• The tracings can help pinpoint the type of arrhythmia and where in the heart it comes from.
• An EKG also shows signs of:
  • Heart attack
  • Heart ischemia
  • Conduction problems
  • Abnormal heart enlargement, called hypertrophy
  • Problems with levels of chemicals, like potassium and calcium, in your heart tissue
• If you don’t have symptoms, your doctor might give you this test if they find signs of atrial flutter when you’re at the doctor's office for something else.

Holter monitor/ambulatory EKG

• You might get this test if you have atrial flutter symptoms but get a normal EKG result. That can happen because arrhythmia comes and goes. Or you may just have premature heartbeats, which aren’t dangerous.
• This test can help your doctor find out if you have a significant arrhythmia and what type.
• You’ll wear the monitor around your neck for a few days while you go about your normal activities.
• It’s connected to EKG electrodes attached to your chest.
• The device records your heart rhythm on a continual basis for 24-72 hours.

Event monitor

• It’s a smaller device that you wear for a longer time.
• You can turn it on when you feel something abnormal.
• Sometimes the doctor can implant an event recorder under the skin, and it can be worn for several weeks or months.

Echocardiogram

• This safe, painless ultrasound test uses sound waves to make a picture of the inside of your heart while it’s beating and between beats. It can find problems with blood flow or damage to your heart muscle.
• It identifies heart valve problems, checks how well your ventricles work, and looks for blood clots in the atria.
• It uses the same technique doctors use to check babies in the womb.

Blood tests

• These tests can check for other causes of a heart rhythm problem, such as thyroid disease.

Goals of Atrial Flutter Treatment

The goals are to control the heart rate, restore a normal sinus rhythm, prevent future episodes, and prevent stroke.

Control your heart rate: The first treatment goal is to control the ventricular rate.

• If you have serious symptoms, like chest pain or congestive heart failure related to the ventricular rate, the doctor will lower your heart rate rapidly with IV medications or electrical shock. (This is called cardioversion.)
• If you have no serious symptoms, you may get medications by mouth.
• Sometimes you may need a combination of oral drugs to control your heart rate.
• You might need surgery to control your heart rate or rhythm, but this is rare.

Restore and maintain a normal rhythm: Some people with newly diagnosed atrial flutter go back to a normal rhythm on their own within 24-48 hours. The goal of treatment is to convert the atrial flutter to a normal sinus rhythm and make sure it doesn’t come back.

• Not everyone with atrial flutter needs anti-arrhythmic medication.
• How fast your arrhythmia returns and the symptoms it causes partly determine whether you’ll get anti-arrhythmic drugs.
• Medical professionals carefully tailor each person's anti-arrhythmic medications to produce the desired effect without creating unwanted side effects, some potentially deadly.

Prevent future episodes: You can do this by taking daily medication to keep your heart beating at a safe and comfortable rate.

Prevent stroke: This devastating complication of atrial flutter happens when a piece of a blood clot formed in your heart breaks off and travels to the brain, where it blocks blood flow.

• Medical conditions that happen together, such as congestive heart failure and mitral valve disease, greatly raise the odds of having a stroke.
• If you have persistent atrial flutter, you might need a blood-thinning drug to prevent your blood from clotting.

Procedures That Treat Atrial Flutter

The first step in treatment is to restore a normal rate and sinus rhythm. There are two ways to do this: medication and defibrillation.

Electrical cardioversion: The doctor gives your heart a shock to regulate your heartbeat. They’ll use paddles, or they'll stick patches called electrodes onto your chest.

First, you'll get medicine to make you fall asleep. Then, your doctor will put the paddles on your chest, and sometimes your back. These will give you a mild electrical shock to get your heart's rhythm back to normal.

Most people only need one. Because you’re sedated, you probably won’t remember being shocked. You can usually go home the same day.

Your skin may be irritated where the paddles touched it. Your doctor can point you toward a lotion to ease pain or itching.

Radiofrequency ablation: This is a type of catheter ablation most often used for atrial flutter. Your doctor puts a thin, flexible tube into a blood vessel in your leg or neck. Then they guide it to your heart. When it reaches the area that’s causing the arrhythmia, it sends out radiofrequency energy (similar to microwave heat) that destroys those cells. The treated tissue helps get your heartbeat regular again.

Atrial Flutter Medications

The choice of medication depends on how often atrial flutter happens, the root cause, your other medical conditions and overall health, and the other drugs you take. The classes of medications used in atrial flutter are:

Heart rate medicines: The most common way to treat atrial fibrillation is with drugs that control your heartbeat. These slow your rapid heart rate so your heart can pump more effectively. Options include digoxin (Lanoxin), beta-blockers, and calcium channel blockers. 

Digoxin belongs to a class of medications called cardiac glycosides. It works by affecting certain minerals (sodium and potassium) inside heart cells. This reduces strain on the heart and helps it maintain a normal, steady, and strong heartbeat.

Beta-blockers slow your heart rate. They include:

• Atenolol (Tenormin)
• Bisoprolol (Zebeta, Ziac)
• Carvedilol (Coreg)
• Metoprolol (Lopressor, Toprol)
• Propranolol (Inderal, Innopran)
• Timolol (Betimol, Istalol)

Others are known as calcium-channel blockers. They also slow your heart rate and cut the strength of contractions. They include:

• Diltiazem (Cardizem, Dilacor)
• Verapamil  (Calan, Calan SR, Covera-HS, Isoptin SR, Verelan)

Heart rhythm medicines: They slow the electrical signals to bring your heartbeat into what’s called a normal sinus rhythm. These treatments are sometimes called chemical cardioversion:

Sodium channel blockers, which slow your heart's ability to conduct electricity:

• Flecainide (Tambocor)
• Propafenone (Rythmol)
• Quinidine

Potassium channel blockers, which slow the electrical signals that cause AFib:

• Amiodarone (Cordarone, Nexterone, Pacerone)
• Dofetilide (Tikosyn)
• Sotalol (Betapace, Sorine, Sotylize)

Anticoagulants: These drugs make your blood less able to clot. This lowers the odds that a blood clot will form in the heart or in a blood vessel and lead to a stroke.

• Apixaban (Eliquis)
• Dabigatran (Pradaxa)
• Enoxaparin (Lovenox)
• Heparin
• Rivaroxaban (Xarelto)
• Warfarin (Coumadin, Jantoven)

Atrial Flutter Care at Home

Most people known to have atrial flutter will be taking prescribed drugs. Avoid taking any stimulants. Talk to your doctor before taking any new medications, herbs, or supplements.

Living With Atrial Flutter

An irregular heart rhythm can affect how well you can work, exercise, and do other activities. To manage it, follow the treatment plan your doctor prescribes. Medicines and other therapies can help control symptoms, like shortness of breath and palpitations, and lower your odds of having a stroke or heart failure.

It’s also important to eat right. Your doctor or a dietitian can help you plan a healthy diet. If you're overweight, losing some pounds may help you control symptoms.

Exercise can also help you manage your heart rhythm. Ask your doctor what types of activities are safe for you, and how to get started in a new program.

Complications

Atrial flutter means your heart doesn’t pump blood as well as it should. When blood flow slows, clots are more likely to form. If one travels to the brain, it can cause a stroke.

A fast heartbeat also makes the heart muscle weaker over time. This can lead to heart failure -- when your heart can't pump out enough blood to supply your body.

Next Steps and Beyond

Atrial flutter does raise your chance of having a stroke. But if you don’t have other heart disease, your outlook is generally quite good. If it happens once without serious heart or lung disease, you may never have it again. If you do have other heart disease, your atrial flutter may come back. If that happens, you should see a heart specialist called a cardiologist.