Atrial fibrillation and atrial flutter

Atrial flutter is also called atrial flutter. This cardiac arrhythmia is closely related to atrial fibrillation and should also be treated as quickly as possible. After all, the complications of these heart conditions can be problematic. Atrial fibrillation is characterized by atrial chaos, while atrial flutter involves a certain order in the contractions of the front chambers (atria) of the heart. That seems less serious, but it is certainly not. The diagnosis is made with numerous tests, including a Holter examination and an exercise test.


  • Atrial fibrillation – a disease of old age?
  • Chaotic heart
  • Atrial fibrillation and heart problems
  • Symptoms
  • The causes can be serious
  • Diseases
  • Complications of atrial fibrillation
  • Treatment of atrial fibrillation
  • What is atrial flutter?
  • Atrial flutter and AV block
  • Symptoms
  • Causes, complications and treatment of atrial flutter
  • Supraventricular arrhythmias


Atrial fibrillation – a disease of old age?

The heart consists of two chambers (atria) and two chambers (ventricles). Through a perfectly coordinated collaboration of the two halves of the heart, the blood is pushed through the atria to the heart chambers . The chambers pump blood through the body. This creates the small and large blood circulation, whereby an exchange of oxygen and carbon dioxide takes place in the lungs via the blood cells. As soon as the cooperation between the atria and the ventricles falters, problems in blood circulation also arise.

ECG, normal heart rate / Source: Blausen Medical Communications, Inc., Wikimedia Commons (CC BY-3.0)

Clot formation A
typical case of atrial fibrillation is that the sinus node has lost command of the atrial chamber contractions. The atria then contract in an uncoordinated and chaotic manner. This is slightly different with atrial flutter. Atrial fibrillation is relatively more common in old age. The danger of this cardiac arrhythmia is, among other things, clot formation in the anterior chambers. Clots that are carried by the blood circulation to other organs, such as the brain, which means that in the case of an untreated arrhythmia, a stroke (cerebral infarction) is always more likely to occur, especially in the elderly.

Chaotic heart

In atrial fibrillation, the sinus node has lost control and command of the electrical conduction of the atria. Impulses arise in various places in the antechambers. This involves countless stimuli that completely disable the sinus node. This chaotic conduction means that the atria functionally almost stand still, which means that they no longer contract effectively to propel blood to the heart chambers.
Fast heart rate
The frequency of the chamber contractions often exceeds 150 beats/minute, and the pulse is also very irregular. This is because the AV node only allows some of the stimuli from the atria to pass through to the ventricles. That’s a good thing, otherwise the ventricles would also start to fibrillate, which is a life-threatening situation. Atrial fibrillation can occur in attacks (paroxysmal) or be continuous in nature.

Atrial fibrillation and heart problems

Some people don’t even feel their heart fibrillating. In old people, it is usually the GP who determines that something is wrong when he takes the pulse and notices that it is irregular. When an ECG (electrocardiogram) was made, it turned out to be atrial fibrillation, or a flutter. As mentioned earlier, untreated atrial fibrillation can cause complications , such as a cerebral infarction. It is important to pay extra attention to this heart condition in the elderly, especially because they are often unable to report to their GP with heart complaints due to social and mental reasons .


The symptoms of atrial fibrillation are diverse and vary in intensity for everyone. A selection from this:

  • Irregular heartbeat.
  • Palpitations (heart pounding).
  • Sweating due to reduced pumping function of the heart (shock).
  • No p waves (sinus node impulse, atrial crests) can be seen on the ECG.
  • Heart medications can mask the symptoms, making the patient virtually symptom-free.
  • Unpleasant feeling in the chest.
  • Fatigue.
  • Faintness.
  • Edema (ankles).
  • Shortness of breath due to reduced pump function.
  • Barely palpable pulse (pulse deficit).
  • Dizziness.
  • Light-headed feeling.
  • Exercise fatigue.
  • Shortness of breath often occurs due to the reduced pumping function of the heart.


Atrial fibrillation (atrial fibrillation) / Source: J. Heuser, Wikimedia Commons (CC BY-SA-3.0)

The causes can be serious

The causes of atrial fibrillation are numerous. However, it is mainly a disease of old age. It occurs in 20 percent of people in their 80s. Sometimes no cause can be found for atrial fibrillation. It is then called a lone atrial fibrillation .


The most common causes are:

  • Rheumatic valve diseases, such as mitral stenosis, or other valve defects.
  • High bloodpressure.
  • Diabetes mellitus.
  • Lung diseases.
  • Calcification of the coronary arteries (coronary sclerosis).
  • Congestive heart failure (heart failure).
  • Tumor in the antechambers.
  • Hyperthyroidism (rapid thyroid function).
  • Acute or old myocardial infarction.
  • Congenital heart disease.
  • A ‘fault’ in the electrical conduction of the heart.
  • Hereditary factors, including a mutation of the SCN5A gene, which plays a role in the potassium-sodium ratio in heart muscle cells.
  • Dilation (widening, enlargement) of often the left anterior chamber (atrium), which in many cases provokes fibrillation .
  • Triggering factors include fever, anemia, physical exertion, alcohol abuse (such as binge drinking) and stress.


Complications of atrial fibrillation

The complications of atrial fibrillation are not minor. The often very fast chamber contractions (> 150 bpm) are at the expense of the pump function. Functionally, there is even a standstill of blood flow in the atria. If an arrhythmia is left untreated, blood clots will form, especially in the atrial appendage. These clots can detach and cause emboli , especially in the lungs and brain. The fast heart rhythm sometimes causes a shortage of oxygen in the heart muscle (angina pectoris), causing complaints such as shortness of breath and chest pain.
Deteriorated heart function
Although atrial fibrillation is not initially life-threatening, this arrhythmia must definitely be treated. Even if there are few complaints. In addition to pulmonary embolism, cerebral infarction and myocardial infarction, untreated atrial fibrillation, regardless of whether the arrhythmia is continuous or paroxysmal, ultimately leads to cardiomyopathy (deterioration of the function of the heart muscle) and congestive heart failure (heart failure).

Treatment of atrial fibrillation

The diagnosis is made using a number of tests, including an ECG, an ultrasound, a Holter examination and an exercise test. Everything is aimed at finding the underlying cause of the arrhythmia. In addition to medicinal treatment of atrial fibrillation (such as with antiarrhythmic drugs/beta blockers, including flecainide and metoprolol), and possibly ablation at a later stage, the treatment is also aimed at preventing clot formation. For low-risk patients, the cardiologist prescribes cardioaspirin (acetylsalicylic acid cardio). Thrombin inhibitors, such as Sintrom and Marcoumar, are administered depending on additional factors that increase the risk of stroke. This also applies to the blood thinner edoxaban (Lixiana). These factors include high blood pressure, age (> 65 years) and other heart defects.
During a prolonged attack with complications, the heart rhythm is restored in the hospital with intravenous administration of medications, such as flecainide, or with the help of a defibrillator. This is called cardioversion , or restoration of sinus rhythm, in which the sinus node regains command over the conduction and frequency of the atrial contractions. The patient is then put back on medication. Furthermore, a healthy lifestyle is important, in which no smoking, sufficient exercise and a low-cholesterol diet (healthy food) are the pillars.

What is atrial flutter?

Atrial flutter resembles and is closely related to atrial fibrillation. The atrial contractions are also no longer effective in this cardiac arrhythmia. The anterior chambers contract very quickly, sometimes up to 400 times per minute. Yet there is no chaos, as with atrial fibrillation, but a certain ordering of the atrial rhythm , which can sometimes even be called regular and can be recognized on the ECG by the very fast sawtooth pattern. Fortunately, in this case too, the AV node only transmits part of the impulses to the ventricles, usually every second or third stimulus (AV block). Atrial flutter must also be treated, because the complications can also be serious.

Atrial flutter / Source: James Heilman / Mysid, Wikimedia Commons (CC BY-SA-3.0)

Atrial flutter and AV block

The complaints resemble the symptoms that occur with atrial fibrillation. However, the difference between the two cardiac arrhythmias is clearly visible on the ECG. Characteristic is the very fast pulse (chamber contractions) of up to 180 beats/minute. The pulse also changes in tempo abruptly due to varying atrio-ventricular conduction , such as from a 2:1 conduction to a 3:1 AV block. Sometimes a flutter turns into fibrillation and vice versa.


The complaints vary and resemble the symptoms of atrial fibrillation. The most important are:

  • Fatigue.
  • Dizziness.
  • Pressure on the chest.
  • Angina pectoris complaints.
  • Unconsciousness due to a greatly reduced pumping function of the heart.


Causes, complications and treatment of atrial flutter

Atrial flutter often occurs as a complication after a myocardial infarction . A previous ablation, or the application of scars in the heart wall to prevent atrial fibrillation and flutter by means of conduction isolation, can also cause a flutter again later. Furthermore, the causes that underlie atrial fibrillation can also be observed in atrial flutter.
Generally speaking, the method of diagnosing and treating atrial flutter is virtually the same as for atrial fibrillation. The complications of atrial flutter can also be significant, such as congestive heart failure, cardiomyopathy and emboli in the lungs and brain due to clot formation in the heart atria.

Supraventricular arrhythmias

The heart conditions mentioned above are called supraventricular arrhythmias. The conduction problems therefore occur above the heart chambers. There are many types of arrhythmias , including the life-threatening ventricular fibrillation. It is very important that people with atrial fibrillation, atrial flutter and other cardiovascular diseases continue to take the anticoagulation medications (blood thinners) prescribed by the cardiologist every day, as well as the heart medications, even if the heart complaints are now minor. The general practitioner and cardiologist are the designated persons for questions about this.

read more

  • Atrial fibrillation and acetylsalicylic acid cardio (aspirin)
  • Atrial fibrillation and flecainide
  • Metoprolol against cardiac arrhythmias and high blood pressure
  • Edoxaban (Lixiana) – blood thinner for atrial fibrillation
  • The insidious Adams-Stokes syndrome