Diagnostics

First of all, the flutter is examined more closely in order to be able to select the appropriate therapy method. It is important to know whether it is a typical or atypical atrial flutter and whether thrombi may already have formed in the atria. For this purpose, an ECG is taken to better localize the site of origin.

Here, the two forms of flutter can also be distinguished from each other. In addition, an ultrasound of the heart can be performed to rule out the possibility that thrombi have already formed in the atria. The electrical excitation can be visually displayed and recorded by an ECG (electrocardiogram).

Electrodes are attached to the chest according to a certain pattern, which can measure an excitation of the heart cells as a change in voltage. This process is also known as recording.This is done between 2 electrodes each, each pair of electrodes can be assigned a derivative. The characteristic image of a heartbeat is created, in which both the electrical activation of the atria and the ventricles as well as the excitation recovery of the heart can be read.

In addition, the existing sequence of beats can be used to display the frequency and regularity of the heart action. It is also possible to determine the position of the heart by combining the individual leads with each other. This examination procedure is painless, does not interfere with the body and can provide a variety of information. For example, cardiac dysrhythmia, disturbances in the conduction and propagation of excitation, a heart attack or myocarditis become apparent in an ECG. Atrial flutter can also be depicted in an ECG and is the main method of diagnosis.

Treatment

Since existing atrial flutter can lead to strokes after thrombus formation in the left atrium or to a too fast contraction of the ventricles, a therapy should be aimed for quite quickly. The goal here is to end the atrial flutter and to allow the heart to return to a normal beat rhythm. The cardioversion procedure is often used for this purpose.

On the one hand, this can be done with antiarrhythmic medication, i.e. medication that restores the normal rhythm. On the other hand, this effect can also be brought about by a current surge to the heart, which equates the activity of all heart cells. With the latter procedure, the success rate is slightly higher, but if a thrombus already exists in the atrium, it can lead to the loosening of this thrombus and cause a stroke, for example.

Both types of cardioversion can lead to other cardiac arrhythmias. Another treatment option is catheter ablation. It can be used both as a procedure of first choice and after the failure of a drug therapy.

However, a prerequisite is that the point of origin of the self-activated excitation in the atrium is known. This is done by means of so-called mapping, in which the atria can be displayed three-dimensionally using a specialized procedure. The point of origin is then searched for by means of a catheter and attempts to obliterate the tissue at exactly this point with an electrical impulse in order to interrupt the excitation.

If this attempt succeeds, the sinus node again takes over the sole rhythm control. Atrial hyperstimulation is also available as a further procedure. Here, the heart rhythm is set slightly higher than normal using a pacemaker.

Some models can detect the actual heart rate and then set a slightly higher rhythm. It has been shown that this prevents a renewed atrial flutter. For each type of therapy, certain conditions must be met which contribute to the success of the therapy.

During an existing atrial flutter, it may be necessary to take medication for blood clotting. Due to the very rapid contraction of the atria, the normal amount of blood cannot be transported into the chambers, and the pumping function is limited. Some of the blood remains in the atrium and the blood flow slows down.

This composition of circumstances can lead to the formation of blood clots in the atrium. If this blood clot breaks loose, it is carried by the blood flow into the chamber and possibly into the lungs or brain. There, depending on its location, it could trigger a pulmonary embolism or a stroke.

This risk can be reduced by taking anticoagulants, but the aim is always to find a therapy that eliminates atrial flutter with as little loss of time as possible. If anticoagulants are taken for a certain period of time, the general risk of bleeding increases during this time, even in the case of harmless injuries. A drug therapy of atrial flutter proves to be very difficult.

For this reason, catheter ablation (“targeted obliteration”) is the therapy of choice for atrial flutter. Furthermore, ablation is a therapy option where the patient can be completely cured of atrial flutter (curative method). In catheter ablation, a catheter is pushed over a vessel in the groin or hand area and into the right atrium.

In the typical case of atrial flutter in the tricuspid valve region, the surrounding heart muscle tissue can be scarred with the catheter, which suppresses the transmission of impulses. In the case of atypical atrial flutter, the circulating excitation must first be precisely localized with the help of the ECG findings before an ablation is performed.Catheter ablation is mainly used for recurrent atrial flutter or chronic atrial flutter. There is a very high probability of success (over 95%).

The duration of the treatment is usually about 2 hours. General anesthesia is not required for this therapy. Another therapeutic option for atrial flutter is electrical cardioversion.

Here, with the help of electric shocks, an attempt is made to convert the disturbed heart rhythm back into sinus rhythm and to maintain this rhythm. The correction of the heart rhythm is carried out depending on the ECG (difference to acute defibrillation). The surge is ECG-triggered at the time of the R-wave in the ECG.

Cardioversion takes place under continuous ECG monitoring and short intravenous anesthesia. Therefore the cardioversion is painless for the patient. It represents an alternative to catheter ablation, especially in cases of very pronounced symptoms of atrial flutter or an acutely life-threatening disturbance of the heart pump function.

The implantation of a pacemaker for atrial flutter is the treatment option of last resort. An implantation becomes necessary if the above mentioned therapeutic approaches do not lead to an improvement of the symptoms or if the heart rate cannot be slowed down with the help of medication. Usually, the implantation of a pacemaker is performed with simultaneous catheter ablation of the AV node. This allows the pacemaker to take over the function of the heart‘s electrical clock.