Atrial Flutter
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This page is courtesy of Florida Electrophysiology Associates; The leader in the Southeast United States in complex catheter ablation procedures

Normal Rhythm

Atrial Flutter


Atrial flutter occurs when the atria are stimulated to contract at 200-350 beats per minute usually because electrical impulses are traveling in a circular fashion around and around the atria. Often the impulses are traveling around an obstacle like the mitral valve, tricuspid valve or the openings of the superior or inferior vena cavae.


The mechanism of Atrial Flutter
The atrial flutter waves, known as F waves, are observed. F waves are larger than normal P waves and they have a saw-toothed waveform.  The ventricular rate (or pulse rate) is usually regular but slower than the atrial rate. The two ECGs above illustrate normal rhythm, on top, versus atrial flutter below.  During normal rhythm, the ECG baseline is flat between heartbeats. During flutter, a "saw tooth" baseline is seen. The saw tooth baseline is the result of the atria beating at about 300 beats per minute (normal rate 60-120)

Atrial flutter can be treated medically, by electrical shock or by ablation.  Medical therapy includes any of several dozen types of heart rhythm control medications.  Medical therapy will also often include therapy with the blood thinner coumadin as patients who remain in atrial flutter are at increased risk for stroke.  Electrical shock of a patient in flutter with the paddles can restore normal rhythm but nothing has been done to this patients heart save for resetting it and flutter will often restart after a period of time.

The only curative approach to atrial flutter is catheter ablation.  During a flutter ablation, a catheter is threaded into the heart from the right groin vein and the site in the right atria where the impulse is spinning in circles (the fundamental cause of flutter) is identified.  This never ending circle is cauterized with the ablation catheter terminating flutter permanently.  Typical flutter can be successfully ablated to permanent cure in greater then 95% of all patients.  Medical therapy is no longer needed in any of these people  Even other non-typical flutter like macrorentrant atrial arrhythmias have a slightly lower success rate of between 80 and 90% success

The ablation of atrial flutter is a relatively easy catheter ablation procedure.  The procedure uses only two or three tubes placed into the groin using local anesthetic with some mild sedation is all that's needed for this procedure. Following a successful flutter ablation, the tubes are removed and pressure is held to the femoral vein access sites for several minutes. The entire ablation procedure lasts a little under one hour in the typical flutter patient.  Following bed rest, patients are then free to ambulate and if stable are discharged latter that day. Most patients can resume all normal activities the next day.

Typically patients who were on medications for flutter are instructed to discontinue these drugs after a flutter ablation,  Coumadin can also at times be stopped.  Which medications you will need to continue after a successful ablation is ultimately up to you referring cardiologist but generally we suggest weaning certain anti-arrhythmic drugs to off while continuing coumadin at least for a time until which it's clear that no other heart rhythm problems persist.








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