Atrial flutter: treatment, symptoms and causes

BHF says 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, or ablation. The right mix depends on your symptoms, your heart and your stroke risk, and it is decided with a doctor or cardiologist.

Because atrial flutter can lead to a blood clot forming in the heart, treatment usually also considers a blood thinner, covered in the section on stroke risk below.

BHF describes two types of cardioversion. Pharmacological (chemical) cardioversion uses medicine, swallowed or given into a vein, and can work in minutes, hours or even days. Electrical cardioversion uses an external defibrillator to send controlled electric signals to the heart through electrodes (sticky pads) on the chest.

During electrical cardioversion you are given a short-acting general anaesthetic so you are asleep and unaware. The procedure usually lasts a few minutes. Afterwards you are monitored until the anaesthetic wears off, and BHF says in the first 24 hours you should not drink alcohol, drive or operate heavy machinery.

BHF says your doctor may recommend blood thinners for a few weeks after cardioversion even if you do not have any blood clots. Complications are rare, but the treatment might not work, it can cause a skin rash or skin burns from the electrodes, and very rarely a clot in the heart may break off and cause a stroke. If your rhythm comes back, the procedure may be repeated, and after a few cardioversions a different treatment is usually recommended.

BHF explains that ablation, or catheter ablation, treats some kinds of irregular heart rhythm by using heat or cold energy to create tiny scars in the heart. The scars block the faulty signals and restore a typical heartbeat. Arrhythmias are usually treated with medication first, and an ablation may be offered when medication does not work or cannot be used.

Thin, flexible tubes called catheters are passed through a small cut in the groin or wrist and guided up into the heart. BHF says the shortest ablation can take as little as 15 minutes while a more complex one can take three or four hours, and you will have either local or general anaesthetic. Recovery usually takes a few days to a week, you will usually stay in hospital overnight, most people can drive again after a few days, and you should avoid heavy lifting for at least two weeks.

The main points to discuss with the specialist include the small chance of bleeding or bruising where the catheter went in and a small risk of damage to the heart's normal electrical pathways, which can mean needing a pacemaker. If the first ablation does not work or symptoms return, BHF says you may need another ablation or to consider other treatments.

Your heartbeat is controlled by an electrical system that makes the upper chambers (atria) and the lower chambers (ventricles) work together to pump blood. BHF explains that in atrial flutter this pathway is interrupted and a new, smaller faulty pathway forms in the atria. Because the new circuit is so small, impulses travel very quickly around the atria, making them beat at around 300 beats per minute.

The ventricles cannot pump as fast as the atria, which means they beat at different speeds. BHF says this puts the heart under strain.

BHF says people with atrial flutter often have no symptoms. When symptoms are present they can include the following, and BHF advises speaking to your GP if you have them, especially if you already have a heart condition.

• Palpitations.

• Shortness of breath.

• Feeling very tired (fatigue).

• Feeling light-headed.

• Fainting.

• Tightness in the chest.

BHF says people with atrial flutter often have an underlying cause. More rarely it is caused by other conditions, and sometimes it happens without any cause.

• Common underlying causes named by BHF: previous cardiac surgery, coronary heart disease, heart valve disease, congenital heart disease and high blood pressure.

• More rarely: cardiomyopathy, inflammation of the heart such as myocarditis, or another condition such as lung disease or an overactive thyroid.

• Some people have atrial fibrillation as well, with periods of flutter followed by periods of fibrillation.

The two are related rhythm problems of the upper chambers of the heart and can occur in the same person. NHS and BHF descriptions of atrial fibrillation are useful for comparison.

BHF says your doctor should recommend an ECG or Holter monitor test to look at the electrical activity of your heart. You may need more than one ECG, because sometimes the atrial flutter does not show up. You may also have an implantable loop recorder fitted under the skin to record the heart's electrical activity for longer.

For atrial fibrillation, which is closely related, the NHS says a GP may refer you to a cardiologist who checks your heart rate and arranges tests that can include an ECG, an echocardiogram, a chest X-ray and blood tests. The same kind of work-up is often used to look for causes such as thyroid or valve problems.

BHF explains that atrial flutter can change the way blood moves through the heart. This can lead to a blood clot forming, and if the clot breaks off it could cause a stroke. To reduce this risk you may need to take an anticoagulant medicine such as warfarin or a NOAC.

If left untreated, BHF says atrial flutter can also weaken the heart over time and cause heart failure. This is why it is worth having a rhythm problem assessed even when symptoms are mild.

BHF advises speaking to your GP if you have palpitations, breathlessness, light-headedness, fainting or chest tightness, especially if you already have a heart condition.

The NHS page on atrial fibrillation, a closely related rhythm problem, says to call 999 if you currently have a fast or irregular heartbeat and also have chest pain, shortness of breath, sweating, feeling or being sick, fainting or dizziness, a severe headache, weakness or numbness on one side of the face or body, blurred vision or loss of sight, or confusion or difficulty speaking. It says not to drive yourself to A&E.

BHF says that with treatment you should be able to continue to do everything you enjoy, although it can take time to understand what triggers your atrial flutter and you may need to make some changes. It can also have an emotional impact on you and your family, and BHF suggests speaking to loved ones and your GP if you feel more anxious or stressed than usual after the diagnosis.

If atrial flutter returns after treatment, follow up with your doctor, because further treatment may be needed. BHF runs a Heart Helpline staffed by cardiac nurses for questions.

On the NHS, assessment usually starts with a GP and an ECG, with referral to cardiology for rate control, cardioversion or ablation planning. Waiting times for specialist procedures vary by area.

Some people choose private cardiology for faster ECG monitoring or ablation. The medicines and procedures are the same in either setting. Ask who will oversee your anticoagulant treatment and follow-up, and make sure your GP receives the results.