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The explanation here is beyond the scope of the post, but keep in mind that most patients with atrial flutter also have at least the tendency for AFib See number The diagnosis of atrial flutter can be tricky. This is important because there are flutter-specific treatments. Atrial flutter is diagnosed from the EKG. It takes some skill. Sometimes it is easy, but it also can be subtle. Over-diagnosis, under-diagnosis and mis-diagnosis are not uncommon.
I see coarse AFib diagnosed as atrial flutter. Likewise, I see atrial flutter often called AFib. And I have even seen slower versions of atrial flutter missed altogether. That never makes me mad. Heart rate control of atrial flutter: Just like it is in AFib, it is important to get the pulse rate under control.
In most cases, this does not have to happen immediately. In fact, attempts at rapid heart rate control can lead to problems. Things that lower adrenaline levels help lower the heart rate in atrial flutter, like peace, quiet and transiently limiting exertion. The most common drugs for rate control are the beta-blockers by far the best , calcium-entry blockers, and digoxin.
Recall that rate control is the means for preventing heart muscle weakness heart failure. Persistent tachycardia, over weeks to months, can weaken the heart muscle. The good news is such muscle weakness is rarely permanent; the bad news is atrial flutter is tougher to rate control than AFib. See number 2. Stroke prevention in atrial flutter: The atria in flutter contract rapidly and often ineffectively.
This increases the risk of blood pooling, clots and subsequent stroke. Rhythm control drugs rarely work to control atrial flutter. Rhythm control therapy of atrial flutter differs greatly from AFib.
In fact, most rhythm drugs not beta-blockers, Ca-E blockers or dig can create a favorable milieu for atrial flutter. This is especially relevant to athletes on AF-drugs.
Athletes who take AF-rhythm drugs without beta-blockers or Ca-E blockers can sustain dangerously high heart rates during exercise. I tell athletes who take these drugs to either not exercise, or stop exercising, if they feel like their heart is out of rhythm. Let me explain: remember I told you flutter was a circular circuit. The slower the circuit, the more time the tissue has had to recover, and the more likely it is that the circular rhythm persists.
They can also be associated with conditions unrelated to the heart. Also, some people with AFL feel no symptoms at all. Because of this complexity of pinpointing AFL symptoms, it is always a good idea to discuss any concerns with your doctor. Researchers do not know for certain what causes atrial flutter. It is thought to result from damage to the heart, its electrical system, or to parts of the body that affect the heart.
A natural pacemaker the sinus node controls your heart rate. It sends out electrical signals to both the right and left atria. Those signals tell the top of the heart how and when to contract.
When you have AFL, part of the signal from the sinus node travels abnormally fast in a continuous loop around the right atrium. This makes the upper chamber of the heart beat too quickly at between to beats per minute bpm , and the lower chambers usually at about bpm the upper beats conduct in a ratio to the bottom chamber.
In contrast, a normal resting heart rate is between 60 to bpm, where the upper and lower chambers are beating at the same rate. This is the rate at which the lower part of the heart pushes out blood to the rest of the body. It is the rate that you commonly measure when you touch the neck or wrist, or use a medical instrument or smart device.
It is sometimes difficult to pinpoint the precise root cause. Conditions in other parts of the body that affect the heart can also contribute to the development of AFL.
Examples include:. No products in the cart. Sign in Sign up. Search for:. Introduction to ECG Interpretation. Clinical electrocardiography and ECG interpretation. Arrhythmias and arrhythmology. Mechanisms of cardiac arrhythmias: from automaticity to re-entry reentry. Conduction Defects.
Overview of atrioventricular AV blocks. Atrial and ventricular enlargement: hypertrophy and dilatation on ECG. Exercise stress test treadmill test, exercise ECG : Introduction. Section 2, Chapter In Progress. ECG in atrial flutter. Atypical atrial flutter. Treatment and management of atrial flutter. Section Progress. Atrial flutter: from ECG to clinical management Atrial flutter is the second most common pathological tachyarrhythmia. Doctors typically give an anticoagulant Anticoagulation Pulmonary embolism is the blocking of an artery of the lung pulmonary artery by a collection of solid material brought through the bloodstream embolus —usually a blood clot thrombus or People who cannot be given an anticoagulant may be given aspirin , but aspirin is not as effective as warfarin.
Otherwise healthy people who had only one episode of atrial fibrillation that converted to normal rhythm spontaneously or with treatment need anticoagulant treatment for only 4 weeks. People who had several episodes of atrial fibrillation or atrial flutter or who remain in such rhythms despite treatment should take a drug to prevent blood clots indefinitely.
Doctors use warfarin or other anticoagulants for people who have one or more risk factors for developing stroke. Such risk factors include. Some people without those risk factors are given aspirin , and some are not given any treatment to prevent strokes. This anticoagulant treatment is needed because the arrhythmia may come back without the person being aware of it. Dangerous blood clots can form during these episodes.
The following is an English-language resource that may be useful. American Heart Association: Atrial fibrillation : Information about symptoms and diagnosis of atrial fibrillation and resources for people living with atrial fibrillation.
From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. The Merck Manual was first published in as a service to the community. Learn more about our commitment to Global Medical Knowledge. This site complies with the HONcode standard for trustworthy health information: verify here. Common Health Topics. Commonly searched drugs.
Ranitidine Withdrawn from US Market. Atrial fibrillation. Atrial flutter. Slowing the heart rate Restoring normal heart rhythm Ablation procedures Preventing blood clots.
More Information. Abnormal Heart Rhythms. Test your knowledge. Which of the following is the most common cause of coronary artery disease? More Content. Click here for the Professional Version. These disorders often result from conditions that cause the atria to enlarge. ECG: Reading the Waves. Atrial Flutter Atrial flutter is a regular rhythm with characteristic "flutter" waves in a sawtooth pattern.
The main complications include the following:. Blood clots in the atria. Did You Know Doctors usually also do blood tests to look for an overactive thyroid gland. Slowing the heart rate. Electrical shock synchronized cardioversion. Age 65 or older. Generic Name Select Brand Names procainamide. Was This Page Helpful? Yes No. Atrial Premature Beats.
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