Atrial fibrillation/flutter Health Article

Symptoms

• Sensation of feeling heart beat (palpitations)
• Pulse may feel rapid, racing, pounding, fluttering, or it can feel too slow
• Pulse may feel regular or irregular
• Dizziness, light-headedness
• Fainting
• Confusion
• Fatigue
• Shortness of breath
• Breathing difficulty lying down
• Sensation of tightness in the chest

Note: Symptoms may begin or stop suddenly.

Signs and tests

Listening to the heart with a stethoscope shows fast heart beat. The pulse may feel rapid, irregular, or both. The normal heart rate is 60 to 100, but in atrial fibrillation/flutter the heart rate may be 100 to 175. Blood pressure may be normal or low.

An ECG shows atrial fibrillation or atrial flutter. Continuous ambulatory cardiac monitoring -- Holter monitor (24 hour test) -- may be necessary because the condition is often sporadic (occurring at some times but not others).

Tests to determine the presence of underlying heart diseases may include:

• Echocardiogram
• Nuclear imaging tests
• Coronary angiography
• Exercise treadmill ECG
• Electrophysiologic study (EPS) may be needed in some cases

Treatment

In certain cases, atrial fibrillation may require emergency treatment to convert the arrhythmia to normal (sinus) rhythm. This treatment may involve either with electrical cardioversion or intravenous (IV) drugs such as dofetilide, amiodarone, or ibutilide.

Long-term treatment varies depending on the cause of the atrial fibrillation or flutter. Medication may include beta-blockers, calcium channel blockers, digitalis or other medications (such as anti-arrhythmic drugs), which slow the heartbeat or the conduction of the impulse from the atria to the ventricles.

Blood thinners, such as heparin or Coumadin, may be given to reduce the risk of a thromboembolic event such as a stroke.

Some selected patients with atrial fibrillation, rapid heart rates, and intolerance to medication may require a catheter procedure on the atria called radiofrequency ablation.

For some patients with atrial flutter, radiofrequency ablation is the current treatment of choice. Some patients with atrial fibrillation and rapid heart rates may need the radiofrequency ablation done not on the atria, but directly on the AV junction (i.e., the area that normally filters the impulses coming from the atria before they proceed to the ventricles).

Ablation of the AV junction leads to complete heart block. Treatment for this condition requires a permanent pacemaker.