Not every individual with atrial flutter will have symptoms. The reason is that healthy individuals can very well tolerate the increase in heart rate; however those with underlying disease conditions can experience pain in the chest, dyspnea, nausea, nervousness, and dizziness. In more severe cases, or when the flutter continues for longer duration, then it can lead to heart failure, or development of nocturnal breathlessness and edema of the legs and abdomen [6].

Patients suffering from atrial flutter have also reported to experience the following symptoms:

• Anxiety
• Tremor-like feeling in the heart accompanied by discomfort in the chest
• Difficulty in carrying out everyday exercise or routine activities
• Palpitations 
• Fainting 

• Fatigue

  This increased heart rate may contribute to symptoms of palpitations, shortness of breath, chest discomfort, light headedness or fatigue when atrial flutter occurs. As with AFib, there are two main goals in the treatment of atrial flutter. [heartrhythmalliance.org]

  Copyright © 2010 Society of Hospital Medicine A 68‐year‐old man with a history of congestive heart failure and hypertension presented to the emergency department with fatigue and dyspnea of 3 weeks duration. [journalofhospitalmedicine.com]

  Others do experience symptoms, which may include: Chest pain, fullness, discomfort or pressure Confused or impaired thinking F.A.S.T: face drooping, arm weakness, speech difficulty and time to call 911 General fatigue or fatigue when exercising Rapid [rwjbh.org]

• Chest Discomfort

  This increased heart rate may contribute to symptoms of palpitations, shortness of breath, chest discomfort, light headedness or fatigue when atrial flutter occurs. As with AFib, there are two main goals in the treatment of atrial flutter. [heartrhythmalliance.org]

  […] pain Angina pectoris, atrial fibrillation, atrial flutter, chest discomfort cs Blíží se k nám gestapácké auto en Atrial fibrillation and atrial flutter are caused by problems in the conduction of electrical impulses in the upper chambers of the heart [cs.glosbe.com]

  Faster rates and variable AV conduction usually cause palpitations, and decreased cardiac output may cause symptoms of hemodynamic compromise (eg, chest discomfort, dyspnea, weakness, syncope). [merckmanuals.com]

• Dyspnea

  In other cases, mild symptoms such as fatigue, dyspnea, chest discomfort, palpitations, or sensation of an irregular heartbeat may be present. [visualdx.com]

  Symptoms include palpitations and sometimes weakness, effort intolerance, dyspnea, and presyncope. Atrial thrombi may form and embolize. Diagnosis is by ECG. [merckmanuals.com]

  Symptoms include palpitations and sometimes weakness, effort intolerance, dyspnea, and presyncope. Atrial thrombi may form and embolize. Diagnosis is by electrocardiography. [msdmanuals.com]

  Copyright © 2010 Society of Hospital Medicine A 68‐year‐old man with a history of congestive heart failure and hypertension presented to the emergency department with fatigue and dyspnea of 3 weeks duration. [journalofhospitalmedicine.com]

• Exertional Dyspnea

  The most encountered signs are fatigue, exertional dyspnea and general discomfort. However this intolerance is often mild. Certain forms are even asymptomatic. [fac.org.ar]

• Nausea

  The reason is that healthy individuals can very well tolerate the increase in heart rate; however those with underlying disease conditions can experience pain in the chest, dyspnea, nausea, nervousness, and dizziness. [symptoma.com]

  […] included APL differentiation syndrome, leukocytosis, prolonged QT interval (#, # with torsade de pointes), atrial fibrillation/ atrial flutter, hyperglycaemia and a variety of serious adverse reactions related to haemorrhage, infections, pain, diarrhoea, nausea [cs.glosbe.com]

  Symptoms Symptoms of atrial flutter are similar to those of atrial fibrillation and may include the following: palpitations, chest pain or discomfort shortness of air lightheadedness or dizziness nausea nervousness and feelings of impending doom symptoms [acls-algorithms.com]

  Use of dabigatran can precipitate bleeding and is a frequent cause of gastrointestinal symptoms, including nausea, heartburn, and bloating. [clinicaladvisor.com]

  […] just a normal response to exercise), however, people with other underlying heart disease (such as coronary artery disease) or poor exercise tolerance may rapidly develop symptoms, such as shortness of breath, chest pain, lightheadedness or dizziness, nausea [en.wikipedia.org]

• Tachycardia

  […] that was shown by fetal magnetocardiography to have transient AFl in addition to atrioventricular reciprocating tachycardia. [ncbi.nlm.nih.gov]

  Atrial flutter, atrial fibrillation, and other primary atrial tachycardias. [experts.umn.edu]

  Types of supraventricular tachycardia include: Atrial fibrillation Atrial flutter Atrial tachycardia Atrioventricular nodal reentrant tachycardia Atrioventricular reentrant tachycardia, also known as Wolff-Parkinson-White syndrome Expand All Collapse [scripps.org]

  Characterization of reentrant circuits in left atrial macroreentrant tachycardia: critical isthmus block can prevent atrial tachycardia recurrence. Circulation 2002 ; 105 : 1934 – 1942. 50. [doi.org]

• Heart Disease

  Two main groups were considered: No PCS and PCS patients, who were further subdivided into acquired heart disease (AHD: ischaemic heart disease and valvular/mixed heart disease) and congenital heart disease [CHD: ostium secundum atrial septal defect [ncbi.nlm.nih.gov]

  A: Atrial flutter is an uncommon arrhythmia but is associated with certain medical conditions such as heart failure, heart disease, alcoholism, diabetes, thyroid disease, or chronic lung disease. [healthline.com]

  disease Congenital heart disease Atrial flutter often presents at a rate of 150 bpm on admission. [nottingham.ac.uk]

• Heart Failure

  It was difficult to control the heart rate with beta-blockers during AFL, which resulted in the deterioration of right-sided heart failure. The effect of anticoagulation therapy for the RA thrombus was also limited. [ncbi.nlm.nih.gov]

  His congestive heart failure (CHF) was treated with increasing diuretics and appropriate treatment for Parkinson's disease was initiated. [journalofhospitalmedicine.com]

• Palpitations

  A 46-year-old man was admitted to our hospital for near syncope and palpitations. An electrocardiogram showed a common type of atrial flutter (AFL) with 1:1 atrioventricular conduction. [ncbi.nlm.nih.gov]

  Amal Mattu’s ECG Case of the Week – December 3, 2018 HPI: A 63-year-old woman presents to the emergency department with palpitations. The following ECG was obtained by EMS prior to arrival: Case ECG Before watching this week’s [...] [ecgweekly.com]

  Atrial flutter is less common than atrial fibrillation Atrial flutter is less common, but has similar symptoms (feeling faint, tiredness, palpitations, shortness of breath or dizziness). Some people have mild symptoms, others have none at all. [bhf.org.uk]

  This increased heart rate may contribute to symptoms of palpitations, shortness of breath, chest discomfort, light headedness or fatigue when atrial flutter occurs. As with AFib, there are two main goals in the treatment of atrial flutter. [heartrhythmalliance.org]

• Chest Pain

  After the procedure, the chest pain was getting worse, and the electrocardiogram showed ST-segment elevation in inferior leads with reciprocal changes. [ncbi.nlm.nih.gov]

  pain Angina pectoris, atrial fibrillation, atrial flutter, chest discomfort cs Blíží se k nám gestapácké auto en Atrial fibrillation and atrial flutter are caused by problems in the conduction of electrical impulses in the upper chambers of the heart [cs.glosbe.com]

  If you have been diagnosed with atrial flutter and are experiencing severe chest pain, you feel faint or light-headed, or you faint, you should go to the emergency room right away. [bonsecours.com]

  Symptoms depend on how fast the ventricles contract and may include palpitations, weakness, dizziness or light-headedness, shortness of breath, and chest pain. Electrocardiography (ECG) confirms the diagnosis. [msdmanuals.com]

• Stroke

  Given the difficulties in detecting AF and the uncertainty about the temporal relation of AF and stroke, oral anticoagulation may need to be continued in those patients with underlying stroke risk factors. © 2016 Wiley Periodicals, Inc. [ncbi.nlm.nih.gov]

  Both conditions carry increased risk of stroke, usually managed by drugs (such as warfarin or a newer anticoagulant). [bhf.org.uk]

  Reducing the Risk of Stroke Some patients with atrial flutter may be at an increased risk of stroke if certain other risk factors are present. [circ.ahajournals.org]

• Dizziness

  This can cause you to feel dizzy or weak. Blood that doesn’t keep moving can pool and form clots in the atria. These clots can move into other parts of the body and cause serious problems such as a stroke. [saintlukeshealthsystem.org]

  Atrial flutter is less common than atrial fibrillation Atrial flutter is less common, but has similar symptoms (feeling faint, tiredness, palpitations, shortness of breath or dizziness). Some people have mild symptoms, others have none at all. [bhf.org.uk]

  The reason is that healthy individuals can very well tolerate the increase in heart rate; however those with underlying disease conditions can experience pain in the chest, dyspnea, nausea, nervousness, and dizziness. [symptoma.com]

  While some might not experience symptoms, some might feel chest pain, dizziness, and shortness of breath. Typically, AFL can be brought on through high blood pressure, alcohol abuse, or past heart incidents, like a heart attack. [bonsecours.com]

  Symptoms depend on how fast the ventricles contract and may include palpitations, weakness, dizziness or light-headedness, shortness of breath, and chest pain. Electrocardiography (ECG) confirms the diagnosis. [msdmanuals.com]

• Quadriplegia

  We report a case of pseudo-atrial flutter in a 67-year-old male with quadriplegia and ventilator dependence due to amyotrophic lateral sclerosis (ALS) who was hospitalized for respite care. [ncbi.nlm.nih.gov]

A preliminary physical examination will be done, followed by the following diagnostic procedures:

• Electrocardiogram [7] 
• Holter monitor: This is a device for continuous recording of the heart beat for 24 to 72 hours.
• Echocardiogram: This is done to evaluate the shape, size as well as motion of the heart. In addition, transthoracic echocardiography is also a preferred mode for evaluating atrial flutter.
• Electrophysiological study: This would help in identifying the exact location of the abnormal rhythm. Such a type of method would also help in treating the condition.

• Narrow QRS Complex

  Unlike right ventricular pacing, which can usually be identified by wide QRS complexes with left-bundle-block morphology preceded immediately by pacing spikes, His-bundle pacing produces narrow QRS complexes mimicking supraventricularly conducted complexes [ahajournals.org]

  To the Editor: Adenosine is the treatment of choice for tachycardia with narrow QRS complexes involving the atrioventricular node as part of its reentrant circuit 1. [nejm.org]

  QRS-COMPLEX TACHYCARDIAS WIDE QRS-COMPLEX TACHYCARDIAS FOCAL ATRIAL TACHYCARDIAS ATRIAL FLUTTER ECG during carotid massage or iv. adenosine injection slows the ventricular rate and demasks atrial waves SVT with BBB: most BBB’s are not rate-related, but [escardio.org]

  Since flutter waves tend to be somewhat wide and rarely fall perfectly inside a narrow QRS complex, you can often find signs of buried waves as slurring in the upstroke or downstroke of the QRS. [ems12lead.com]

  As a supraventricular tachycardia atrial flutter usually exhibits narrow QRS complexes. However fast rate and irregularity predispose to ventricular aberration. [fac.org.ar]

• ST Elevation in All Leads

  Electrocardiogram revealed atrial flutter with rapid ventricular rate and ST elevation in all leads suggestive of pericarditis. The atrial flutter was reverted to sinus rhythm by cardioversion. The patient then had an uncomplicated convalescence. [ncbi.nlm.nih.gov]

• P Wave Absent

  Variable S1 and absent a waves on JVP. Premature atrial complexes – Premature P wave on the ECG, which is usually different in morphology from the normal sinus P wave. Precipitating factors mentioned above may be present. [visualdx.com]

The basic objective of treatment is to reduce the electrical impulses, which would in turn help in normalizing the heart beat. In order to achieve this, the following methods would be employed [8]:

• Medications: Various medications such as beta blockers, adenosine, digoxin and calcium channel antagonists, are administered for treating atrial flutter. In addition, antiarrhythmics would also be required, to treat the condition. These include propafenone, amiodarone, ibutilide, sotalol, flecainide and dofetilide.
• Debrillation: In this method, defibrillation is applied externally, to bring back the heart beat to normal. This method is also known as cardioversion [9].
• Ablation therapy: This is the treatment of choice, and is employed when medications do not work, and individuals experience repeated bouts of atrial flutter. Such a therapy is carried out during the electrophysiological study; wherein the area from where abnormal heart rhythm arises is destroyed with the help of the same catheters [10].
• Anticoagulation: This is important for preventing recurrent bouts of atrial flutter and also help onset of complications from setting in.

When appropriately treated, atrial flutter can be successfully managed, and seldom gives rise to any complications. However, without treatment, it can lead to development of stroke and blood clots [5]. Underlying medical conditions gravely affect the prognosis of atrial flutter. Patients with Wolff-Parkinson-White syndrome, who also suffer from atrial flutter, are at risk of developing life threatening consequences, if catheter ablation is not considered in such cases. Also, untreated atrial flutter can lead to atrial fibrillation, cardiomyopathy and long term disability.

Individuals living with heart disease, or those who have undergone open heart surgery, are at an increased risk of developing atrial flutter. Stress and anxiety can also considerably increase the risk of the condition. Certain medications prescribed for cold, overuse of caffeine, diet pills and alcohol, predispose an individual to develop atrial flutter [2].

In addition to the above mentioned conditions, there are various risk factors that significantly increase the chances of atrial flutter. These include:

• Condition of hyperthyroidism, hypertension and chronic lung disease
• Heart disease such as mitral valve prolapse or hypertrophy
• Conditions that increase stress and anxiety levels

The condition of atrial flutter majorly affects the population of older adults. About 200,000 new cases of atrial flutter are known to occur in the US every year [3]. Men are at an increased risk of developing the condition. In a study of 100 patients suffering from atrial flutter, it was seen that 75% of them were males.

Factors that interfere with the appropriate functioning of the electrical impulses of the heart, may give rise to the condition of atrial flutter. Under normal conditions, the sinus node controls the heart, which is situated on the top of the atrium. In this condition, the atria send out reentrant rhythms that overwhelm the sinus node. Such a phenomenon causes the atria to contract rapidly [4].

The following steps can be taken for preventing attacks of atrial flutter:

• Decrease the consumption of caffeine, alcohol, nicotine and stimulants.
• Prompt treatment for underlying heart ailments.
• Significantly decrease the stress and anxiety levels.

This condition was described and identified as an independent medical condition by British physician Sir Thomas Lewis in the year 1920. Atrial flutter is grouped into the category of supraventricular tachycardia. In this condition, the atria of heart beat so fast, that the muscle contractions of the atria are faster than those of ventricles. Atrial flutter is associated with certain degree of atrioventricular node conduction block [1].

• Definition: Atrial flutter is characterized by abnormal heart rhythms, which arise from the atrial chamber of the heart. It is a rare condition as compared to atrial fibrillation. Males are at an increased risk of contracting this condition than females.
• Cause: Underlying heart disease, stress, anxiety and open heart surgery, predisposes an individual to develop atrial flutter. In addition, caffeine, stimulants, nicotine, alcohol and smoking, also considerably increase the chances of developing atrial flutter.
• Symptoms: Symptoms of atrial flutter include fast paced heart beat, dizziness, lightheadedness, anxiety, shortness of breath and discomfort in the chest. Individuals also complain of tremor-like feeling in the heart.
• Diagnosis: Atrial flutter is diagnosed using the electrocardiogram, echocardiogram, holter monitor and electrophysiological study.
• Treatment: The major goal of treating atrial flutter includes bringing back the abnormal heart beat to normal, and prevention of future attacks. Medications, cardioversion, ablation therapy, and blood thinners are employed for treating attacks of atrial flutter.

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