Atrial flutter (heart rhythm disorder): treatment


What is it about ?

Atrial flutter is a heart rhythm disorder that resembles the atrial fibrillation. But in the event of flutter, the heartbeat remains regular. While with atrial fibrillation it is irregular.

In atrial flutter, the atria of the heart contract very quickly, up to 300 times per minute. Normally, a small electric current is generated in the right atrium. It spreads through the muscle of the heart (the myocardium) and triggers a contraction. In the case of atrial flutter, these electrical impulses arrive too quickly and are too close together, while only part of it is transmitted to the muscles of the heart chambers. In other words, the atria contract far too quickly and the ventricles do not follow.

Atrial flutter can occur with no apparent cause, but it is rare. Usually, it is the result of an underlying condition such as a heart attack (infarction), an overactive thyroid (hyperthyroidism), or a congenital heart defect (hole in the septum that separates the right ventricle from the left). It can go away on its own, but it can just as easily develop into atrial fibrillation. The two heart rhythm disorders are different than with atrial flutter, the atria contract very quickly but regularly, whereas with atrial fibrillation the contractions are very messy.

How to recognize it?

You may have the following symptoms:

  • palpitations,
  • tired,
  • dizziness,
  • tendency to faint,
  • shortness of breath
  • oppressive feeling in the chest.

How is the diagnosis made?

If you have palpitations, your doctor will take an electrocardiogram (ECG). The particularly characteristic sawtooth waves of the ECG make it possible to make the diagnosis.

What can your doctor do?

He will always refer you to a heart specialist (cardiologist).

Acute treatment

The first goal of treatment is to restore a normal heart rhythm. This is possible via an electrical cardioversion. While you are under general (brief) anesthesia, you receive an electric current that flows through your heart. If you have had the disorder for a short time (less than 30 days), it is possible to try cardioversion with drugs. In 60% of cases, the patient returns to a normal heart rhythm with this technique.

Preventive treatment

Preventive treatment aims to prevent relapse after successful acute treatment. In this case, the usual drugs for heart rhythm disturbances, such as atrial fibrillation, are irrelevant: their effect is limited and they can cause serious side effects. Ablation has recently been touted as a definitive solution. During the ablation, the piece of heart tissue that causes the arrhythmia is burned. If the procedure is successful, there is less than 10% relapse.

Atrial flutter increases the risk of blood clots forming, and therefore of stroke. This is why the doctor prescribes anticoagulant therapy as a preventive measure. If the risk is low, a small dose of aspirin will be given. In case of high risk (diabetes, high blood pressure, heart disease, stroke in a family member, etc.), you will need to take anticoagulants. In this case, the doctor will carefully weigh the risk of bleeding against the benefit of preventing stroke.

Sources

Foreign clinical practice guide ‘Treatment of atrial flutter’ (2008), updated on 14.03.2017 and adapted to the Belgian context on 23.06.2019 – ebpracticenet