Atrial Flutter

Atrial flutter is a type of abnormal heart rhythm or arrhythmia that occurs when the upper chambers of the heart, called the atria, beat too fast and in a regular pattern. During atrial flutter, the atria can beat at rates of 250-350 beats per minute, which is much faster than the normal heart rate of around 60-100 beats per minute. The lower chambers (ventricles) beat at a speed of about 150 beats per minute as they can’t keep up with the speed of the atria.
Fig 82 Flutter Converted
Atrial flutter is usually caused by an abnormal electrical circuit that goes around the upper chambers of the heart which leads to a rapid and coordinated contraction of the atria. This abnormal circuit can be the result of various factors, such as heart disease, lung disease, certain medications, or previous ablation procedures.
The risk factors for atrial fibrillation and flutter are similar and in about 30% of the patients with flutter later on develop atrial fibrillation.

There are two main types of atrial flutter:

Typical Atrial Flutter

This is the most common type of atrial flutter, accounting for about 80-90% of cases. In typical atrial flutter, the electrical circuit within the right atrium follows a predictable pattern around the tricuspid valve, which is located between the right atrium and the right ventricle of the heart. This results in a characteristic sawtooth pattern on an electrocardiogram (ECG).

Fig 11 Typical flutter

Atypical atrial flutter

This is a less common type of atrial flutter and can be caused by different electrical circuits around the right or left atrium. Atypical atrial flutter can be more difficult to diagnose and treat, as the ECG pattern and heart rate may vary more widely than in typical atrial flutter.

Fig 10 atypical flutter

Symptoms of atrial flutter can include:


Heart palpitations or a racing heartbeat

sick 1

Fatigue or

difficulty breathing1

Shortness of


Dizziness or light-headedness

chest 1

Chest pain or discomfort

The treatment of atrial flutter is focused on controlling the heart rate with medications initially. Atrial flutter can increase the risk of complications such as stroke, therefore this risk needs to be assessed and if deemed necessary, blood thinners will be prescribed. The abnormal heart rhythm can be restored back to normal rhythm with procedures such as cardioversion. If atrial flutter is recurrent, catheter ablation is an excellent option that offers high chance of maintaining normal rhythm in the long term without medications (>95% typical flutter, 85% atypical flutter). Therefore, if you are experiencing symptoms of atrial flutter, it is important to receive a proper diagnosis and appropriate treatment by a qualified electrophysiologist