Stanford Cardiac Arrhythmia Service

Atrial Flutter

What is Atrial Flutter?
Atrial flutter is a type of atrial arrhythmia in which a rapid, circular impulse travels through the atrium (upper chamber of the heart).  The impulse usually takes the same path over and over again, like a car traveling around a race track.   The rate of the atrium is usually 200 to 300 beats per minute.  The electrical signals then travels from the upper chambers (atria) to the lower chambers (ventricles) via a connector called the A-V node.  The rate of the heart beat is the rate of the ventricles.   Usually the rate of the ventricular beat is between 75 and 150 beats per minute. 

Atrial flutter can occur once in a while or on an ongoing basis.

What Causes Atrial Flutter?
In many cases, no underlying cause for atrial flutter is identified. In some patients, atrial flutter may occur in patients with prior open heart surgery, even occurring many years before.  Some patients with atrial flutter have other heart conditions or a history of high blood pressure.   
What are the Symptoms of Atrial Flutter?
Some people with atrial flutter don’t have any symptoms. Others experience:

Is Atrial Flutter Dangerous?
When a heart doesn’t beat as it should, it doesn’t effectively pump blood to the organs of the body. This may result in the symptoms described above or the patient may have minimal or no symptoms.  Atrial flutter may be associated with an increased risk of stroke. The risk of stroke is assessed using the CHADS2 scoring system (see Atrial Fibrillation CHADS2 score section)

How is Atrial Flutter Diagnosed and Treated?
Medications may be used to treat some patients with atrial flutter.  Medications such as beta-blocking agents such as atenolol, metoprolol, or carvedilol, calcium channel blocking agents such as diltiazem or verapamil, or digoxin may be used to decrease the number of beats that travel from the atria to the ventricles, thus, decreasing the ventricular heart rate.   In addition, some patients may benefit from medications that stabilize the atria.  These medications, called anti-arrhythmic agents, include sotalol, dofetilide, propafenone, flecainide, dronedarone, or amiodarone.  The choice of the medication depends on the presence of heart problems, blockages in the arteries to heart, and other factors.   In some cases, an electrical shock to the chest, called cardioversion, is used to convert the rhythm to normal.   As an alternative to these medications, a technique called catheter ablation may be used to prevent atrial flutter, usually without the need for medications.   In most patients, there is specific path that the electrical signal takes with the atria that is responsible for the atrial flutter. In most cases, there is a specific path or alley-way that is necessary for the atrial flutter to continue.  In such cases, creating a series of energy deliveries that kill islands of cells responsible for conducting the electrical signals may prevent atrial flutter.  Catheter ablation for atrial flutter in most patients is effective in over 80-90% of cases.  Some patients with atrial flutter may develop atrial fibrillation in the future.

  In some cases, particularly patients with prior heart surgery or catheter ablation, there may be multiple electrical pathways. Frequently patients with atrial flutter will be treated with anticoagulation with warfarin to prevent blood clots and stroke.    The Stanford Cardiac Arrhythmia Service provides a wide range of state-of-the-art diagnostic and therapeutic approaches, including catheter ablation, to the management of patients with arrhythmias such as atrial flutter.
Learn more about arrhythmias.

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