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Atrial flutter: why you shouldn't ignore palpitations that linger.

If you feel your heart racing for extended periods, you should seek medical attention. It could be atrial flutter, a serious heart rhythm problem.

Atrial fibrillation (afib) is a common heart rhythm disturbance that gets a lot of attention in Heart Advisor and other sources. And rightfully so, since the condition affects almost one out of every 10 adults in the U.S., age 65 and older.

But you should also be aware of a similar condition, called atrial flutter. Like afib, atrial flutter is a problem with the hearts electrical system. But unlike afib, which involves the chaotic beating of the heart's upper chambers (atria), atrial flutter means the atria beat extraordinarily fast, but in a steady, non-chaotic manner.

However, atrial flutter is similar to afib in that it can raise the risk of stroke, heart failure and other complications. But because atrial flutter presents with palpitations, many individuals may be less likely to seek medical attention because they think the rapid heart rate is due to exertion or some other benign reason.

"You can't ignore atrial flutter," says Oussama Wazni, MD, director of the Outpatient Physiology Department at Cleveland Clinic. "If your heart rate remains fast for days on end, you should be checked out."

Because the heart beats faster in atrial flutter, progress toward heart failure can occur faster than it can with afib.

Flutter and fibrillation

Atrial flutter and afib are abnormal heart rhythms (arrhythmias) that occur when the usual flow of electrical activity in the heart is disrupted.

In a healthy heart, electrical impulses start in the sinoatrial (SA) node near the top of the right atrium. They first cause the atria to contract and send blood down to the heart's lower chambers (ventricles). Impulses then travel through the atrioventricular (AV) node, located between the atria and the ventricles. The AV node sends out a signal to make the ventricles contract, pumping blood out to the lungs and the rest of the body.


A heart experiencing atrial flutter, however, will have a different flow of electrical signals. Impulses will travel around the right atrium in a type of circuit, causing the atria to beat much faster than normal and out of synch with the the ventricles. In afib, impulses also stay within the atria, but the heart rate is irregular, not just accelerated as it is with atrial flutter.

Interestingly, Dr. Wazni notes that once atrial flutter is treated, a doctor may find that Afib was also present.

"If you follow people for long enough, you'll see that 80 percent of them will end up having afib," he says.

Diagnosing atrial flutter

The main symptom of atrial flutter is a prolonged episode of rapid heartbeats. You may have had palpitations before, perhaps after a long tennis match or after overdoing it at a holiday party. Palpitations can also accompany moments of anxiety.

But in episodes of atrial flutter, these abnormal heartbeats tend to last longer than a usual bout of palpitations. Dr. Wazni also notes that atrial flutter episodes are often longer than afib episodes. If you have atrial flutter, you may have other symptoms besides a rapid pulse and a pounding heart rate. Other signs include shortness of breath and dizziness.

Fortunately, atrial flutter is fairly easy to diagnose. If your heart is in atrial flutter, an EKG can detect it. The readout of a heart in flutter is pretty distinct, looking like a "saw-tooth" pattern. If atrial flutter is suspected, your doctor will also listen to your heart, check your heart rate and blood pressure, and perhaps put you through some other tests, such as an echocardiogram or an exercise stress test. A blood test may also help determine if the cause of your irregular heart rate is due to thyroid disease or a potassium imbalance.

Valve disease, a previous heart attack, diabetes and heart failure are among the risk factors for atrial flutter. In some cases, atrial flutter can develop after valve surgery. This is called incisional atrial flutter.

Treating atrial flutter

Unfortunately, medications aren't very effective in controlling atrial flutter, Dr. Wazni says. Afib can sometimes be treated with antiarrhythmic drugs. But for many people with afib and/or atrial flutter, the solution is ablation. This is a procedure that uses tiny, precision radio waves or electrical energy to deaden the tissue causing the arrhythmia.

When ablating the heart for atrial flutter, doctors map the atrium and find the troublesome corridor or isthmus between two points along the chamber's electrical pathways. That corridor is then deadened, usually restoring a healthy rhythm.

While ablation can often be a lasting solution for some patients, for others, the risk of atrial flutter or afib returning is very real. "Even after flutter is treated, the patient must be monitored," Dr. Wazni says. "And if they have hypertension, diabetes, and other risk factors, they should be watched even more closely."
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Title Annotation:ARRHYTHMIAS
Publication:Heart Advisor
Date:May 1, 2016
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