Atrial Flutter

Treatment

At Mayo Clinic, the treatment strategies for atrial flutter are:

• Cardioversion
• Catheter radiofrequency ablation
• Medications
• Medical devices
• Surgery
• Follow-up care

Cardioversion

To correct atrial flutter — reset the heart to its regular rhythm (sinus rhythm) — the physician will often perform a cardioversion in one of two ways:

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 doctors individualize the medication or combination of medications to maximize effectiveness.

Electrical cardioversion
A patient under 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 the heart's electrical activity begins again, it may resume normal rhythm.

Cardioversion is not always effective. It may successfully restore regular heart rhythm in over 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

For atrial flutters caused by abnormal heart tissue, catheter radiofrequency ablation can be used to break the abnormal electrical circuit in the heart's upper chambers (atria). The procedure is performed without open surgery on the chest. Catheters (thin, flexible tubes) are threaded through the patient's blood vessels to reach the abnormal heart tissue. The cardiologist then uses a small cutter or radiofrequency energy to remove the abnormal tissue. When successful, this procedure restores normal rhythm and eliminates the need for daily medications.

Mayo Clinic is a national leader in catheter ablation and implantable devices and uses the most advanced technology to treat arrhythmias.

One type of catheter radiofrequency ablation used to treat atrial flutter is:

Atrioventricular (AV) node ablation with pacemakers
Radiofrequency energy is applied to the atrioventricular (AV) node through a catheter to destroy a small area of tissue, preventing the atria from sending too many electrical impulses to the ventricles. The atria continue to flutter, and anticoagulation medication is still required. In 98 percent of patients, this procedure blocks the heart's electrical impulses. A pacemaker is then implanted to establish normal rhythm.

In a study, 85 percent of people who had this procedure reported an improved quality of life and increased ability to exercise.

Medications

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

Drugs to slow the heart rate

Medications can effectively slow the heart rate.

Digoxin

Digoxin controls the heart rate at rest, but not as well during activity.

Calcium channel blockers or beta-blockers

A newer approach is calcium channel blockers or beta-blockers. These drugs control heart rate more consistently at rest and during activity.

Drugs to prevent blood clots

Patients with atrial flutter have a higher-than-usual risk of stroke. Blood-thinning medications (anticoagulants) such as warfarin (Coumadin) or aspirin, may be prescribed to prevent blood clots that cause strokes.

Medical devices – Pacemakers

A pacemaker 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 a heart rate that is too slow or that the heart is not beating, it emits electrical impulses that stimulate the heart to speed up or resume beating.

A pacemaker is used most often for patients with atrial flutter in one of two situations:

• If medications used to prevent atrial flutter or control the heart rate result in excessively slow heartbeats
• After AV node ablation

Surgical procedures

If the source of the atrial flutter can be identified, surgery might 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. Read more about the maze procedure.

Follow-up care

Many patients who have heart surgery of implanted medical heart devices have benefited from the Mayo Clinic's cardiac rehabilitation program while recovering from heart surgery. The program starts with a walking schedule for the first six to eight weeks after surgery and progresses to more vigorous, supervised physical training.

Mayo Clinic also monitors patients over the long term following heart surgery, including monitoring and adjusting medical devices.