Atrial Flutter

Treatment

At Mayo Clinic, the atrial flutter treatment goals include restoring the heart to normal rhythm, regulating the heart rate and preventing blood clots. A team of cardiologists and other medical specialists collaborate to determine the most effective atrial flutter treatment for each patient. Mayo Clinic cardiologists have experience and expertise in the most advanced treatments available for atrial flutter.

Atrial flutter treatment options include:

• Cardioversion
• Catheter radiofrequency ablation
• Surgery
• Medical devices
• Medications

Cardioversion

To correct atrial flutter — reset the heart to its regular rhythm (sinus rhythm) — the physician will often perform cardioversion, either with drugs or electrically.

Cardioversion with drugs

Medications (antiarrhythmics) are used to stop the atria's quivering and restore normal sinus rhythm. For each patient with atrial flutter, Mayo Clinic physicians individualize the medication or combination of medications to maximize effectiveness. The medications effectively maintain sinus rhythm for at least one year in 50 percent to 65 percent of people. However, medications can cause side effects such as nausea and fatigue, as well as some long-term risks. In rare cases, the medications may actually increase the heart rate.

Electrical cardioversion

A patient who has been given light anesthesia receives an electrical shock through paddles or patches on the chest. The shock stops the heart's electrical activity for a split second. When electrical activity resumes, the rhythm may be normal.

Cardioversion is not always effective. It may successfully restore regular heart rhythm in more than 95 percent of patients, but more than half of those eventually return to atrial flutter. In many instances, antiarrhythmic medications are needed indefinitely.

Catheter Radiofrequency Ablation

Mayo Clinic is an international leader in catheter ablation and uses the most advanced technology to treat arrhythmias, including atrial flutter. Mayo has treated thousands of patients with arrhythmias using catheter ablation, with excellent success. Patients benefit from the expertise and experience of the catheter ablation team at Mayo Clinic. Catheter radiofrequency ablation is a minimally-invasive procedure performed without opening the chest. For atrial flutters caused by abnormal heart tissue, catheter radiofrequency ablation can destroy the abnormal tissue.

In this procedure, catheters (thin, flexible tubes) are threaded through the patient's blood vessels to reach the abnormal heart tissue. The cardiologist then applies radiofrequency energy to remove the abnormal tissue. When successful, this procedure restores normal rhythm and eliminates the need for daily medications. Catheter radiofrequency ablation may destroy the atrial flutter, but it does not lower the risk of developing other heart rhythm disorders.

One type of catheter radiofrequency ablation used to treat atrial flutter is atrioventricular (AV) node ablation with pacemaker placement. In AV node ablation, a catheter is placed near the atrioventricular (AV) node (the electrical connection between the atria and ventricles). Radiofrequency energy is applied through the catheter to destroy a small area of tissue. The radiofrequency energy prevents the atria from sending too many electrical impulses to the ventricles. In almost all patients, this procedure blocks the heart's electrical impulses. Once the AV node is destroyed, doctors then need to implant a pacemaker to establish normal rhythm. After this procedure, the patient will need a pacemakers for life. Anticoagulation (blood-thinning) medication is required after the procedure to reduce the chance of developing blood clots.

Surgical Procedures

If the source of the atrial flutter can be identified, surgery may be recommended to remove the problem spot in the heart muscle or to disrupt the electrical signals causing the flutter. However, at Mayo Clinic, this surgery is only done if other options have been ineffective. Surgery is usually performed only if the atrial flutter is occurring with other heart conditions. Read more about the maze procedure.

Medical Devices — Pacemakers

A pacemaker is a medical device that helps regulate the heartbeat. The device, smaller than a matchbox, is placed under the skin near the collarbone. A wire extends from the device to the heart. If a pacemaker detects an abnormally slow heart rate or no heartbeat, it emits electrical impulses that stimulate the heart to speed up or start beating again.

A pacemaker is used most often for patients with atrial flutter if medications used to prevent atrial flutter or control the heart rate result in excessively slow heartbeats; and also following AV node ablation.

Medications

Medications may be prescribed alone or combined with other treatments. Medications include:

• Drugs to slow the heart rate — When atrial flutter is too fast and cannot be stopped using cardioversion, the goal is to slow the heart rate.
• Drugs to try to prevent atrial flutter
• Drugs to prevent blood clots — Patients with atrial flutter are at especially high risk of stroke. Blood-thinning medications (anticoagulants) or aspirin may be prescribed.

Follow-Up Care

Patients will need to have follow-up appointments with cardiologists to ensure that heart rhythms and rates remain under control.

Mayo Clinic also monitors patients for several months following heart surgery, including monitoring and adjusting medical devices.