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Atrial Flutter

What is atrial flutter?

Atrial flutter is an abnormal heart rhythm. Atrial flutter causes the heart to beat very rapidly. The normal resting heart rate is about 70 beats-per-minute. The heart rate during atrial flutter is often between 100 and 300 beats-per-minute. Atrial flutter can last for a few minutes or may continue indefinitely (or until stopped with treatment).

What causes atrial flutter?

Atrial flutter is caused by an electrical short circuit in the heart. Some causes of electrical short circuits in the heart include high blood pressure, heart valve disease, heart muscle disease, previous heart attacks, congenital heart disease (heart disease present since birth), lung disease and previous heart surgery. In many cases the cause of the atrial flutter cannot be determined (this is known as idiopathic atrial flutter).

How does the short circuit cause atrial flutter?

The heart is composed of millions of heart cells. The heart uses electrical currents to tell the heart cells when to contract so that they contract in a coordinated fashion. When this orderly flow of electricity is disrupted by a short circuit, abnormal heart rhythms result.

What symptoms does atrial flutter cause?

Most people with atrial flutter notice a rapid pulsation from the heart beating quickly in the chest. Other symptoms may include: dizziness, fainting, chest tightness or chest pain, difficulty breathing and tiredness.

Is atrial flutter dangerous?

Atrial flutter can have serious consequences: prolonged rapid beating of the heart can cause the heart to pump inefficiently causing fluid to accumulate in the abdomen, lungs or in the lower limbs (known as heart failure). Atrial flutter also increases the risk of stroke. However, in most cases, the bad effects of atrial flutter can be minimised with medication.

What brings on attacks of atrial flutter?

In most cases atrial flutter simply occurs randomly and cannot be predicted. In some patients attacks are brought on by recent surgery or chest infections such as pneumonia or bronchitis.

Will atrial flutter get better without treatment?

In many patients the atrial flutter does not stop spontaneously and continues until stopped with medication, an electrical shock administered by your doctor (known as an “electrical cardioversion”) or catheter ablation (see below).

Will I continue to have further episodes of atrial flutter?

Once you have had one or two attacks of atrial flutter you are likely to have further attacks of atrial flutter unless the atrial flutter was caused by recent heart surgery.

What are the treatment options for atrial flutter?

If attacks do not cause severe symptoms, are short lived and not very frequent, no treatment may be required. However, if attacks are starting to interfere with the activities of daily life treatment should be considered. The two main types of treatment are medication and catheter ablation (see below)

What do I do if I have an attack of atrial flutter – do I need to go to hospital?

If you feel unwell during an attack you should see your doctor or attend the emergency department of your closest hospital.

Can atrial flutter be cured with medication?

Medications do not cure atrial flutter. Taking regular medications may decrease the number of attacks of atrial flutter in some patients but medication is rarely very effective in completely preventing attacks. To prevent attacks of atrial flutter medications usually need to be taken every day. Some medications cause side effects but these side effects are not always severe. Medications usually need to be taken for life.

What is catheter ablation?

Catheter ablation is a technique for curing atrial flutter. The aim of catheter ablation is to destroy the short circuit which causes atrial flutter. Catheter ablation is always performed in a hospital and usually takes 1 ½ – 2 hours. The procedure is usually performed under general anaesthetic or heavy sedation. Most patients stay in hospital overnight following catheter ablation. Small wires (called catheters) are placed in the veins at the top of the thigh and passed up these veins into the heart. The electrical short circuit is located and then an electric current is passed down one of the wires to destroy the short circuit. The electric current produces a small burn about the size of a pea. Usually this burn does not cause ill effects. Following the procedure, the doctor removes the catheters. The patient is left with several small wounds in the groin just a few millimetres across. These are not usually painful. Sutures (stitches) are not usually inserted in the wounds, which heal by themselves.

What are the chances that catheter ablation will cure atrial flutter?

The success rate for the common or “typical” type of atrial flutter is very high (typically 95-98%. In the 2-5% of cases where the ablation is not successful, a repeat procedure is usually successful. Some “atypical” or uncommon types of atrial flutter are more difficult to cure and catheter ablation has a lower success rate in these cases – particularly when the atrial flutter is a result of congenital heart disease or previous surgery to repair or replace the mitral valve.

What are the risks of catheter ablation of atrial flutter?

The risks of the procedure are generally small. The risk of death, heart attack or a stroke are <1% (approximately 1 in 500 to 1 in 2000 depending upon the location of the short circuit). The risk of needing a pacemaker as a result of catheter ablation is <1% (about 1 in 500 to 1 in 1000). Other risks include bleeding, infection, blood clots in the leg or minor damage to the nerve or blood vessel in the leg, this risk is approximately 1-2% (1-2 in 100). In some patients the atrial flutter is caused by previous surgery to replace or repair the mitral valve – in these patients there is a risk of damaging the mitral valve or trapping the catheter in the artificial mitral valve – either of these complication could require surgical treatment.

When can I return to work?

Many people feel well enough to return to work 2-3 days after the procedure. However, many patients feel tired for a few days afterwards and it is recommended that the patient considers taking a week off work.

Will I feel unwell after catheter ablation?

Following catheter ablation patients usually do not feel unwell. You may have a sore throat from the breathing tube inserted by the anaesthetist. Their may be minor discomfort in the groin. Occasionally patients feel some minor chest tightness.

When do I get out of bed following catheter ablation?

It is recommended patients remain in bed for approximately four hours after catheter ablation. It is important you do not move your legs for these first few hours to decrease the risk of bleeding or bruising.

Can I have catheter ablation if I am pregnant?

No. Because x-rays are used to guide the catheters, catheter ablation should not be performed on pregnant women except in an emergency. If you think you might be pregnant it is important to inform the doctor before undergoing catheter ablation.

Do I need to stop my medications before catheter ablation?

You should discuss this with Professor McGuire. Some anti-arrhythmic medications (medications used to control atrial flutter) should be stopped prior to catheter ablation. The decision whether to continue blood thinning medications depends on many factors – see below.

Blood thinning medications:

1) Aspirin (Aspro, Disprin, Cartia, Cardiprin)
is usually continued

2) Warfarin
May or may not be continued depending on the circumstances. If you are asked to stop the warfarin you should stop it 5 days before the procedure. If you are asked to continue the warfarin you should have your INR (blood test) performed 48-72 hours before the procedure and telephone Professor McGuire with the result (telephone 9519-5922).

3) Clopidogrel
(trade names Plavix or Iscover) is usually stopped 1 week before the procedure unless you have received a “heart stent” in the last 6 months.

4) Dabigatran
(trade name Pradaxa) should be stopped 48 hours before the procedure.

5) Enoxaparin
(trade name Clexane): this medication, which is given by injection, should not be given on the day of the procedure.

© Dr Mark McGuire 5/1/2016 (version 1.2)

More info: please click on the links below

American Heart Association
Heart Rhythm Society