Atrial flutter and atrial fibrillation are arrhythmias similar to each other and can coexist, that is, both occur in the same patient. We can sometimes have one type at one point in a lifetime and the other at a different time.

We could have only one text for these two arrhythmias, but for the sake of better understanding, they will be explained separately.

"Understanding the flutter auricular"


Heartbeats are often fast

Atrial flutter is an arrhythmia characterized by a very fast, but regular heartbeat. It can climb beyond 150 beats per minute.


Arrhythmia located in the atria

Atrial flutter, like atrial fibrillation, is located in the auricles, the upper chambers of the heart.

The rhythm of contraction of the atria turns to more or less 300 beats per minute. This very fast frequency prevents the atria from contracting effectively.


A new "speeded" conductor

This arrhythmia silences the usual conductor of the heart, also called the sinus node.

If we say that atrial fibrillation is an electrical cacophony due to orchestra anarchy, the flutter is rather an electric tornado because of its circuit that turns too fast.


Rapid and orderly bombardment of the "customs officer"

The auriculo-ventricular node, customs officer of the heart’s electric passage towards the ventricles, is bombarded by electrical impulses originating in the auricles.

In the case of an atrial flutter, the customs officer filters the very fast rhythm generated in the atria.


It usually lets one pulse out of two go by, causing a heart rate of about 150 beats per minute.

The heart rate can be slower when the customs officer is sick or under the effect of the medication.


Risk of clot formation in the heart

The major risk of atrial flutter is embolism in the arteries, including the brain.

Since the atria do not contract effectively during a flutter episode, a blood clot can form on the walls of the atria since the blood stagnates rather than circulates. Pieces of this clot can loosen and move into the bloodstream resulting in emboli in the arteries.

If the clot pieces make it up to the brain, a stroke occurs and serious repercussions can change a life.

Despite this possible complication, atrial flutter is considered a benign arrhythmia.


                                             We can very well live with auricular flutter


No symptoms or perception of palpitations

In some patients, atrial flutter may be completely symptomless, that is, the palpitations are not perceived. Other patients may experience rapid and uncomfortable palpitations that become sources of anxiety while some may suffer from fatigue, inability to provide physical effort or shortness of breath.



5-10% of the affected population without an identifiable cause

The incidence of auricular flutter, or the frequency of this condition in the general population, is 5 to 10% according to the age. The causes of atrial flutter are multiple but sometimes there isn’t any identifiable cause. We therefor talk about an "idiopathic" flutter.


It is known that older patients with high blood pressure, diabetes, or heart failure are more likely to have atrial flutter. Like atrial fibrillation (see other text or link), some diseases or problems may contribute to the appearance of atrial flutter. For example;

• A narrowing of the arteries of the heart

• Inflammation of the heart's envelope, the pericardium

• Pulmonary problems

• Certain problems of the thyroid gland, a gland that influences the body's metabolism


It is not uncommon to see this arrhythmia after cardiac or thoracic surgery. Nearly one in three patients have atrial flutter and / or atrial fibrillation in the days following these types of operations.


Two treatments

Auricular flutter is treated in two ways: either by controlling the heart rate by slower it, or by controlling the cardiac rhythm, or stopping the arrhythmia. In the latter case, we aim to bring the heart back to its regular and normal rhythm, as in the absence of the flutter.


Heart speed control

There are advantages and disadvantages in both of these ways. For some patients, the doctors favor one while for others, they favor the other.


In general, if there aren’t any symptoms related to the arrhythmia, it is easier to control the frequency, the speed of the heart.


In rare situations, the frequency may become too slow when trying to control it. We will then consider installing a cardio-pacemaker, or simply called a pacemaker, to ensure adequate frequency. The pacemaker provides the necessary electricity when the heart rate becomes too slow; otherwise, it goes into standby mode.


Eliminate arrhythmia: medications or specialized procedure

Despite adequate and controlled heart rate, the patient may still feel uncomfortable to the point where his or her condition affects everyday activities. The doctor may then turn towards a oral medication so that the heart retrieves a regular and normal rhythm.


If the oral medication is ineffective or if the patient develops side effects, another option is the "electrical cardioversion" which consists in regulating the heart rate by an electric shock.


Electrical "cardioversion"

Electrical "cardioversion" is a method by which the heart regains its normal or regular rhythm by applying an electric shock on the thorax. This is not the theatrical method that we see on TV when the patient is lifted from the stretcher at the time of the electric shock…


The real "cardioversion" requires that an anesthesiologist puts a patient to sleep for a few minutes. Once sleep is provoked, the electrical treatment is applied and the waking phase follows.


Like any procedure, "cardioversion" carries risks. The attending physician will explain risks and benefits to the patient when this procedure is chosen. In such a scenario, it is believed that the benefits outweigh the risks.


"Fulguration" or burning of the atrial flutter

The doctor can also suggest a procedure called "fulguration". This is the treatment generally favored by most people or when the usual treatments have not given the expected success.


This intervention firstly identifies the electrical circuit of atrial flutter in the atria, then burns it with electric waves (radiofrequency).

This procedure will be detailed later.


Chronicle or episodes

Atrial flutter can be present chronically, therefore permanently, or periodically. This last situation is called "paroxysmal atrial flutter".


The purpose of anticoagulation is not to make the blood clearer, but to reduce the risk that clots are formed.


Prevent clot formation and embolism

The doctor will decide if an anticoagulant medication is necessary for the patient after he or she analyses factors such as age, the presence of diabetes, high blood pressure, stroke history and heart failure. Once the medication has begun, it is for life in the vast majority of cases.

The doctor must weigh the risk of embolism against the risk of bleeding, in cases where he decides to give such a medication.


Prescribing this anticoagulant is a serious matter. The desired effects are to protect you against strokes. It is normal that you do not feel the effects.


Never stop on your own

You should not stop this therapy without the advice of a health professional who is well aware of your situation.


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18 June 2018


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