Atrial Flutter Treatment in Delhi, India

Atrial flutter (AFL) is a type of arrhythmia characterised by a rapid but regular heartbeat originating in the atria, the heart's upper chambers. This condition frequently results in poor blood circulation and heightens the likelihood of blood clots and strokes.

While it shares similarities with atrial fibrillation (AFib), atrial flutter's rhythm is more organised and regular. Timely diagnosis and intervention are essential for managing symptoms, avoiding complications, and enhancing overall quality of life.

Alternate Name of Atrial Flutter

Supraventricular arrhythmias

Types of Atrial Flutter

There are several types of atrial flutter, including:

Typical atrial flutter

The most common form, where the electrical impulse follows a circular path within the right atrium.

Reverse typical atrial flutter

Similar to typical flutter but with the electrical circuit moving in the opposite direction.

Atypical atrial flutter

Less common and can occur in either atrium, often after heart surgery or catheter ablation.

Recognising the type of atrial flutter aids in determining the most appropriate treatment approach.

Atrial Flutter Symptoms

Atrial flutter often presents with distinct symptoms, though they may vary in severity:

• Palpitations: Noticeable rapid or irregular heartbeats that can be unsettling.
• Fatigue: Persistent tiredness due to the heart's reduced efficiency in pumping blood.
• Shortness of breath: Breathing difficulties, especially during physical activities, caused by insufficient oxygen supply.
• Dizziness or lightheadedness: Sensations of fainting or unsteadiness caused by reduced blood circulation to the brain.
• Chest pain: Chest discomfort or tightness, often mistaken for a heart attack.
• Fainting: Temporary loss of consciousness, particularly during episodes of rapid heartbeats.
• Weakness: A general feeling of weakness, especially during exertion.

These symptoms differ from other arrhythmias and warrant medical attention, especially if they are persistent or severe.

Atrial Flutter Causes

Atrial flutter can be triggered by various underlying factors, including:

• Heart disease: Conditions such as coronary artery disease or hypertension that strain the heart.
• Previous heart surgery: Procedures, especially involving the atria, can disrupt normal heart rhythms.
• Lung diseases: Chronic obstructive pulmonary disease (COPD) and other lung conditions can affect heart function.
• Electrolyte imbalances: Abnormal levels of electrolytes such as potassium or magnesium can lead to arrhythmias.
• Alcohol consumption: Excessive alcohol intake is a known trigger for atrial flutter episodes.

Identifying these causes helps in crafting a personalised treatment plan.

Stages of Atrial Flutter

Different stages/types of atrial flutter are-

Occasional atrial fibrillation

In it, atrial fibrillation occurs from time to time. Paroxysmal atrial fibrillation is another name for it, and it can last anywhere from a few minutes to several hours. The signs and symptoms may fade away on their own.

Persistent atrial fibrillation

Atrial fibrillation that persists. The heart rhythm does not return to normal on its own. To restore and maintain a normal cardiac rhythm, the person may require cardioversion or pharmaceutical treatment.

Long-standing persistent

It persists for a long time. It is ongoing and lasts for more than a year.

Permanent

The abnormal heartbeat cannot be corrected in this type of atrial fibrillation. Medications are required to keep the heart rate under control and prevent blood clots.

Atrial Flutter Diagnosis

Diagnosing atrial flutter involves several tests:

Electrocardiogram (ECG)

A primary tool to detect abnormal heart rhythms.

Holter monitor

A portable device that continuously monitors heart activity for 24 to 48 hours.

Event monitor

Similar to a Holter monitor but worn longer to capture intermittent symptoms.

Echocardiogram

A heart ultrasound to evaluate its structure and functionality.

Electrophysiology study (EPS)

An invasive test to map the heart's electrical activity and pinpoint the source of arrhythmias.

Accurate diagnosis is critical for selecting the right treatment and preventing complications.

Atrial Flutter Treatment

Treatment aims to restore normal heart rhythm and prevent future episodes.

Medications

• Antiarrhythmic drugs: Medications that help restore normal rhythm and prevent future episodes.
• Blood thinners: These reduce the risk of stroke by preventing blood clots.
• Beta-blockers and calcium channel blockers: Help control heart rate and reduce symptoms.

Cardioversion

• Electrical cardioversion: A method in which an electrical shock is administered to the heart to restore its normal rhythm.
• Chemical cardioversion: Involves administering medications to restore normal rhythm without a shock.

Cardioversion is generally effective, though it may need to be repeated in some cases.

Catheter Ablation

• How it works: A minimally invasive procedure where a catheter destroys the area causing the arrhythmia.
• Candidate selection: Ideal for those with recurrent atrial flutter or who do not respond to medications.
• Risks and benefits: While highly effective, it carries risks such as bleeding or infection.

Lifestyle Changes

• Healthy diet: A diet low in sodium and unhealthy fats helps manage heart conditions.
• Regular exercise: Promotes overall heart health and reduces arrhythmia risks.
• Stress management: Techniques such as meditation or yoga can help prevent arrhythmia triggers.
• Monitoring and follow-up care: Regular check-ups are vital to adjust treatment plans as needed.

Lifestyle changes complement medical treatments and can reduce the frequency of atrial flutter episodes.

Risk Factors of Atrial Flutter

Certain factors increase the likelihood of developing atrial flutter:

• Age: The risk increases with age, especially after 60.
• Gender: Males are more likely to develop atrial flutter than females.
• Heart conditions: Pre-existing conditions like heart failure or valvular heart disease raise the risk.
• Lifestyle factors: Smoking and excessive alcohol use are significant contributors.
• Genetics: A family history of arrhythmias can predispose individuals to atrial flutter.

Understanding these risk factors is important for both prevention and early intervention.

Complications of Atrial Flutter

Atrial flutter can lead to several serious complications:

• Increased risk of stroke: Blood clots formed due to inefficient heart pumping can lead to strokes.
• Heart failure: The heart may weaken over time, leading to heart failure.
• Thromboembolism: Blood clots can travel to other body parts, causing blockages.
• Recurrence: Even after treatment, atrial flutter can return, necessitating ongoing management.

Addressing these complications early is key to improving long-term outcomes.

Prevention of Atrial Flutter

Preventive strategies include:

• Healthy heart tips: Maintaining a balanced diet, regular exercise, and avoiding smoking are foundational for heart health.
• Avoiding triggers: Limiting alcohol and managing stress help reduce the likelihood of arrhythmias.
• Regular medical check-ups: Timely detection and intervention can prevent atrial flutter from progressing.

These steps are vital for those at risk and those already diagnosed with atrial flutter.

Primary Prevention of Atrial Flutter

Basic preventive strategies that can help prevent atrial flutter (or A-fib) are -

• Give up smoking
• Eat a Mediterranean-style diet to keep your heart healthy (high in plant-based foods, fruits, and vegetables, and low in saturated fats)
• Physically active & maintaining a healthy weight. If you are obese or overweight, try to keep a normal weight. Limit your intake of alcohol and caffeine
• Blood sugar, blood pressure, and cholesterol levels should all be kept at a safe level.
• Increase your physical activity by exercising every day.

Secondary Prevention of Atrial Flutter

A preventative therapy used to prevent the recurrence of the Atrial flutter includes -

• Take your prescriptions regularly, and make sure you follow the surgeon's medication and dietary recommendations.
• Keep a symptom diary. Write down any quivering episodes you have and the time and other symptoms you are experiencing.
• Recognize Triggering Variables. Make a list of potential triggering factors for an irregular heartbeat, such as stress, caffeine, and alcohol. It is possible to avoid these triggers if you are aware of them.

Managing Atrial Flutter Long-Term

Long-term management focuses on:

• Regular check-ups: Monitor heart health and adjust treatments as needed.
• Treatment adjustments: Medications or procedures may need to be revised based on how the condition evolves.
• Complication management: Ongoing vigilance is required to manage potential complications like stroke or heart failure.

Effective long-term management can significantly improve quality of life and reduce the risk of severe outcomes.

When to Seek Emergency Care

Emergency care is necessary if:

• Signs of stroke: Sudden weakness, difficulty speaking, or vision problems require immediate medical attention.
• Heart failure symptoms: Severe shortness of breath, leg swelling, or fatigue may indicate heart failure.
• Persistent atrial flutter symptoms: If symptoms are severe or do not resolve, seeking immediate care is critical.

Epidemiology of Atrial Flutter

The prevalence of AF in the general population rises with age, from 0.12–0.16 per cent in those under 49 years old to 1.7–4.0 per cent in those 60–70 years old and as high as 13.5–17.8 per cent in those over 80 years old. AF incidence and prevalence are larger among men and women who are older at the time of AF diagnosis. They have a larger risk for AF-associated adverse outcomes such as morality and stroke. Based on findings from epidemiological research, males with a higher BMI appear to have a higher risk of AF.

Expected Prognosis of Atrial Flutter

Overall mortality increases as a result of atrial flutter. It usually transitions to normal sinus rhythm or atrial fibrillation within a week, but it might last weeks or months on rare occasions.

Natural Progression of Atrial Flutter

Although atrial flutter is rarely fatal initially, it does reduce the efficiency with which your heart pumps blood. This can result in a blood clot forming in your heart. A stroke could occur if the clot breaks loose. Atrial flutter can cause a fast heartbeat if left untreated. The duration and frequency of AF paroxysms generally increase over time, and many patients eventually develop permanent AF.

Pathophysiology of Atrial Flutter

Atrial flutter is classified as “typical” or “atypical” depending on the location of the short circuit (the pathway that allows the electrical signal to move too fast around the heart)

• The right atrium is where typical atrial flutter occurs.
• Atrial flutter that originates in the left atrium is known as atypical atrial flutter.

Frequently Asked Questions

1. What is the difference between atrial flutter and atrial fibrillation?

Atrial flutter involves an abnormally rapid heartbeat, while atrial fibrillation is an irregular, chaotic rhythm. Both can cause similar symptoms but differ in their heart rhythm patterns.

2. Can you live a long life with atrial flutter?

Yes, with proper management and treatment, many people live a long, healthy life despite having atrial flutter.

3. How does atrial flutter affect my body?

Atrial flutter can reduce the heart's efficiency, leading to symptoms like palpitations, fatigue, and dizziness, potentially increasing stroke risk.

4. How long does the atrial flutter last?

Atrial flutter episodes can last from minutes to hours. Some may experience it intermittently, while others have persistent symptoms.

5. Can atrial flutter be cured?

Yes, atrial flutter can often be cured through catheter ablation, which targets and eliminates the abnormal electrical circuits causing the arrhythmia.

6. Can a flutter cause heart failure?

If left untreated, atrial flutter can weaken the heart, leading to heart failure, especially in those with existing heart conditions.