Atrial Flutter (cont.)
Most people with atrial flutter have some form of underlying heart disease.
They require medical treatment to reduce their heart rate and to maintain a
normal sinus rhythm (normal heart rhythm). The goals of treatment are to control
the heart rate, to restore a normal heart rate and sinus rhythm, to prevent
future episodes, and to prevent stroke.
Control heart rate: The first treatment goal is to control the ventricular
If no serious symptoms have occurred, the person may be given medications
Sometimes, a combination of oral medications is required to control the
In some people, an invasive procedure called radiofrequency catheter ablation may provide long-term successful treatment, and no additional
medications may be needed. Radiofrequency catheter ablation is a technique that
electronically burns and destroys some abnormal conduction pathways in the
- If a person experiences serious clinical symptoms, such as chest pain or
congestive heart failure related to the ventricular rate, the health care
provider in the emergency department will decrease the heart rate rapidly with
IV medications or controlled electrical shock (defibrillation) performed under
anesthesia. Defibrillation is a technique that uses electrical current to shock
the heart back to a normal sinus rhythm. Defibrillation is sometimes called DC
- Defibrillation is performed by connecting a device called an external
defibrillator to the chest with patches or paddles.
- When this technique is performed in a hospital, an anesthetic drug is first
given so the person is fully sedated and asleep during the procedure; no pain is
associated with the procedure.
- Defibrillation works very well; more than 90% of people convert to a normal
sinus rhythm. For many, however, this is not a permanent solution-the arrhythmia
- Defibrillation itself increases the risk of stroke and thus, if time
allows, requires pretreatment with an anticoagulant medication, usually for
- The abnormal pathways are located, and a catheter is placed at this
precise location in the conduction system.
- After proper placement, the catheter delivers radiofrequency energy that
interrupts (ablates) a portion of the abnormal electrical conduction pathway.
This ablation inactivates the abnormal pathway to provide the normal flow of
- This technique is safe. When it works, atrial flutter may be permanently
cured. Radiofrequency catheter ablation has few complications and, unlike
surgery, requires little recovery time.
Restore and maintain a normal rhythm: Some people with newly diagnosed atrial
flutter convert to a normal rhythm spontaneously in 24-48 hours; however, the
atrial flutter may recur. The goal of treatment is to keep the heart rate normal
and to prevent the heart from beating too fast.
- Not everyone with atrial flutter needs anti-arrhythmia medication.
- The frequency with which the arrhythmia returns and the symptoms it causes
partly determine whether anti-arrhythmia medication is indicated.
- Medical professionals carefully tailor each person's anti-arrhythmia
medication to produce the desired clinical effect without making the dose too
- Most of these anti-arrhythmia medications cause unwanted side effects,
which limit their use.
Prevent future episodes: Prevention usually involves taking daily medication
to keep the heart in a normal rhythm.
Prevent stroke: Stroke is a devastating complication of atrial flutter.
Stroke occurs when a piece of a blood clot formed in the heart's left atrium
breaks off and travels to the brain, where it blocks blood flow.
- Coexisting medical conditions, such as coronary heart disease with atrial
flutter, significantly increase the risk of stroke.
- Most people with atrial flutter, including all people older than 65 years,
should take a blood-thinning drug called warfarin (Coumadin) to lower this risk.
Warfarin blocks the action of certain factors in the blood that promote
clotting. In the short term, most patients are put on IV or subcutaneous
(administered by injection under the skin) heparin, a drug that immediately
decreases the risk of blood clots. A decision is then made
whether oral warfarin is needed on a long-term basis.
- People at a lower risk of stroke and those who cannot take warfarin may use aspirin. Aspirin is not without its own side effects, including bleeding problems and stomach ulcers.
Noel G Boyle, MB, BCh, MD, PhD
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