Also known as Cavotricuspid Isthmus (CTI)-Dependent Flutter
So, you’ve been diagnosed with atrial flutter, what does that mean?
In the United States, approximately 200,000 people are diagnosed with A-flutter every year. It is the second most common heart rhythm problem in the United States. When managed well, people with atrial flutter can live normal and healthy lives.
What is Atrial Flutter?
Atrial flutter is a type of abnormal heart rhythm that occurs when the heart’s upper chambers (the atria) beat too fast in a coordinated pattern. This electrical problem causes the heart to pump fast and less efficiently. It is closely related to a common abnormal heart rhythm called atrial fibrillation.
Why do people get atrial flutter?
The exact cause of atrial flutter is not always clear, but there are several factors that can increase the risk of developing this condition. Some common causes and risk factors for atrial flutter include:
- Advanced age
- Male gender
- Coronary artery disease
- Structural heart disease
- High blood pressure
- Thyroid disease
- Drinking too much alcohol, using drugs, and nicotine
- Previous heart surgery
- Heart Failure
- Diabetes
- Being Overweight
- Serious illness or infection can trigger atrial flutter
- Lung Disease
- Sleep apnea
Is Atrial Flutter Dangerous?
A-Flutter can feel very scary, but it is not deadly. If A-Flutter is not treated properly, it can cause health complications including:
- Embolic Events: blood clots can form in the heart and injure the brain (stroke) or other body parts
- Heart Failure: condition in which the heart’s pumping ability is weakened
- Atrial fibrillation:
Signs & Symptoms of Atrial Flutter
Some people do not have any symptoms when they are in A-flutter. Other people have bothersome symptoms. Signs and symptoms of A-flutter include:
- Feeling overtired or having little to no energy
- Trouble with everyday exercises or activity
- Fast or irregular pulse
- Palpitations (feelings of having fast-beating, fluttering, or pounding heart)
- Shortness of breath
- Chest pain, pressure, tightness, or discomfort
- Dizziness or lightheadedness
- Mental fogginess
- Fluid retention/acute congestive heart failure (leg swelling, weight gain, difficulty breathing particularly with activity or lying flat, abdominal distension)
- Fainting (unusual)
- Increased urination
What should I do for an A-Flutter Episode?
If you’ve had this problem before and it feels similar to past ones, and you feel okay, you can do your normal activities. Pay attention to how your body feels and rest if you need to. You can try some relaxing exercises like meditation or deep breathing. Take note of how long the problem lasts, how you feel during the episode(s), and if you’re having episodes more or less often than before. Tell your doctor about all these things when you see them next.
Heart rhythm symptoms to call your provider about:
- Heart rate greater than 120 beats per minute at rest, lasting more than 1 hour
- Weight gain of 3lbs overnight, or 5 lbs in 1 week
- Dizziness
- Lightheaded
- Changes in your shortness of breath that worry you
- Mild discomfort in your chest
- Symptoms feel worse than usual, or you start feeling worse
- Bothersome episode that has lasted longer than 24 hours
Heart rhythm symptoms to go to the ER for:
- Moderate-to-severe chest pain
- Fainting or feeling like you might faint
- New-onset shortness of breath or difficulty breathing at rest
- Signs of Stroke (sudden weakness, numbness, visual changes, facial drooping, difficulty speaking, trouble walking, change in level of alertness, extremely severe headache)
How is Atrial Flutter Diagnosed?
- Ambulatory Rhythm Monitoring
- ECG (also called EKG): a non-invasive test that records the heart’s electrical activity for 10 seconds.
- Wearable Devices: (Link from Heart Rhythm Society)“Be Smart with Your Heart: Smart Devices and AFib”
- Pacemaker or Defibrillator check: sometimes people have these implanted devices for other health problems and A-fib happens to be found on a device check
How is Cavotricuspid Isthmus (CTI)-Dependent Flutter Treated?
Control other health conditions that impact A-flutter: exercise, weight loss, moderating/quitting alcohol, quitting drugs, treating sleep apnea, and controlling chronic diseases such as hypertension, coronary disease, diabetes, heart failure, thyroid disease, and lung disease can greatly impact how much A-flutter you have.
- Aerobic Exercise: Talk to your provider before starting an exercise program. Aim for at least 150 minutes of aerobic exercise per week. SDCA has many tools to help you reach your exercise goals including exercise physiologists on staff who can help you develop a customized exercise program, exercise classes , and Walk With a Doc.
- Stop smoking: Colorado Quitline Website
- Limit caffeine intake: some people find that caffeine can trigger A-flutter, especially if they drink too much.
- Limit or stop drinking alcohol: alcohol can trigger A-flutter and can make it worse. Avoiding alcohol altogether is best, but if you choose to drink, limit your alcohol intake to less than 2 drinks/day for men or less than 1 drink/day for women. Changing your relationship with alcohol can be incredibly challenging, and often support is needed. Talk with your primary care provider about your alcohol intake and habit change goals. There are also many online and in-person resources including, but not limited to, Alcoholics Anonymous.
Stroke/Embolic Event Prevention
- Vitamin K antagonists: Coumadin (Warfarin)
- Direct-Acting Oral Anticoagulants (DOACS): Eliquis (apixaban), Xarelto, (rivaroxaban), Pradaxa (dabigatran), Savaysa (edoxaban)
Rate Control
- Commonly Used Medications: metoprolol, carvedilol, atenolol, propranolol, diltiazem, verapamil, Digoxin
- Atrioventricular (AV) Node Ablation
Rhythm-Control Approaches
- Commonly used medications: flecainide, propafenone, amiodarone, Betapace (sotalol), Tikosyn (dofetilide)
- Atrial Flutter Ablation
