Atrial flutter

What is atrial flutter?

Your heartbeat is controlled by an electrical system. It makes the upper chambers (atria) and lower chambers (ventricles) of your heart work together to pump blood around the body.

If you have atrial flutter this electrical pathway is interrupted and a new, circular faulty pathway forms in the atria instead.

Because the new pathway is so small, the impulses travel very quickly around your atria. This causes your atria to beat much faster than it should (around 300 beats per minute instead of the usual 60-100).

Your ventricles can’t pump as fast as the atria. This means your atria and your ventricles beat at different speeds, putting your heart under strain.

What are the symptoms of atrial flutter?

Although people with atrial flutter often have no symptoms, symptoms can include:

• palpitations
• shortness of breath
• fatigue 
• feeling light-headed
• fainting
• tightness in your chest

If you're experiencing any of these symptoms, especially if you already have a heart condition, speak to your GP.

What causes atrial flutter?

People with atrial flutter often have an underlying heart or circulatory condition such as:

• previous cardiac surgery
• coronary heart disease
• heart valve disease
• congenital heart disease
• high blood pressure

More rarely, atrial flutter can be caused by:

• cardiomyopathy
• inflammation of the heart (such as myocarditis)
• another condition, such as lung disease or overactive thyroid

Sometimes atrial flutter can occur without any cause.

Some people with atrial flutter may also have atrial fibrillation and experience periods of atrial flutter followed by periods of atrial fibrillation.

What's the difference between atrial flutter and atrial fibrillation?

Atrial fibrillation is when the upper chambers of the heart (atria) beat irregularly. This causes the atria to twitch, leading to an abnormal heart rhythm.

Atrial flutter is when the atria beat regularly, but much faster than usual. The top part of the heart beats quicker than the bottom, causing an abnormal heart rhythm.

How is atrial flutter diagnosed?

Your doctor should recommend you have an ECG or Holter monitor to look at the electrical activity of your heart. You may need to have more than one ECG, as sometimes the atrial flutter doesn't show up.

You many also have an implantable loop recorder fitted under your skin to record the electrical activity of your heart for a longer period. 

How is atrial flutter treated?

Your doctor might recommend treatment with:

• medicines to control your heart rate such as beta blockers, calcium channel blockers and other anti-arrhythmic medicines
• cardioversion
• ablation

Possible complications

Atrial flutter can change the way blood moves through your heart. This can lead to a blood clot forming in your heart. If the clot breaks off it could lead to a stroke.

To reduce this risk of having a stroke, you may need to take an anticoagulant medicine, such as warfarin or a NOAC.

If left untreated, atrial flutter can also weaken the heart over time and cause heart failure.

Living with atrial flutter

With treatment, you should continue to do everything you enjoy after your diagnosis. However, it can take time to understand what triggers your atrial flutter and you may need to make some changes. 

Living with atrial flutter can also have an emotional impact on you and your family. You may be feeling more anxious or stressed than normal after your diagnosis. If this happens you may wish to speak to your loved ones and your GP for further support.

How to get support:

Being diagnosed with atrial flutter and living with atrial flutter symptoms can feel overwhelming, so we are here to help. To get support, you could:

• Chat with online, email or call our expert cardiac nurses.
• Talk to your GP about getting talking therapy. If you're in England, you can refer yourself for therapy through Improving Access to Psychological Therapies (IAPT). Depending on where you live, you could see the Scottish Association for Mental Health, Inspire (Northern Ireland), or Hafal (Wales).  
• Speak to others with heart conditions by joining a support group or online community.
• Join a Heart Support Group near you.
• Sign up to our Heart Matters magazine and online information, packed with health and lifestyle tips.