Atrial Flutter
Atrial Flutter: A Complete Patient Guide
Atrial flutter is a heart rhythm disorder in which the upper chambers of the heart (the atria) beat very rapidly, usually around 300 times a minute, in a regular, organised circuit. The lower chambers usually respond to only some of these beats, so the pulse is often a regular 150 beats per minute (2:1 conduction), though it can be slower or irregular.
It is closely related to atrial fibrillation (AF) and the two often occur in the same person. Like AF, atrial flutter increases the risk of stroke, because blood can stagnate in the atria and form clots, and prolonged fast rates can weaken the heart.
The common type, typical (cavotricuspid isthmus-dependent) flutter, has a well-defined circuit in the right atrium, and can be cured in most people by catheter ablation, with a success rate exceeding 90%. This is one of the most effective procedures in electrophysiology and is often recommended as a first-line treatment.
Atrial flutter is managed using the same principles as AF in the 2024 ESC guideline, namely assessing stroke risk, controlling symptoms and treating associated conditions.
Symptoms are similar to those of atrial fibrillation, and some people have none.
Common symptoms
A rapid, regular heartbeat or pounding in the chest
Breathlessness, particularly on exertion
Tiredness and reduced exercise tolerance
Light-headedness or dizziness
Less common symptoms
Chest discomfort or tightness
Fainting (uncommon)
Symptoms of heart failure if the rate has been fast for a prolonged period
No symptoms
Some people have atrial flutter found on a routine ECG or after a stroke. It still needs assessment, because the stroke risk is the same.
Atrial flutter often occurs on a background of another condition, and finding it is part of the assessment.
Common associations
Atrial fibrillation (the two often coexist or alternate)
High blood pressure, heart failure and heart valve disease
Coronary artery disease and previous heart attack
Previous heart surgery or ablation for AF (a scar-related, “atypical” flutter)
Triggers and other risk factors
Chronic lung disease and obstructive sleep apnoea
Overactive thyroid, obesity, diabetes and heavy alcohol intake
Acute illness, such as infection, surgery or a chest problem
Advancing age and male sex
Sometimes no cause is found
Atrial flutter can occur in apparently healthy hearts, and in athletes.
A fast regular heartbeat that is new or persistent should be recorded and assessed.
Arrange a prompt assessment if you have:
Episodes of a rapid, regular heartbeat, with or without breathlessness or tiredness
A diagnosis of atrial flutter or AF and a change in symptoms
A smartwatch or home monitor alert for a fast or irregular rhythm
Unexplained breathlessness, reduced stamina or dizziness
Call 999 immediately if you have:
Signs of a stroke: face drooping, arm weakness or slurred speech
Chest pain or pressure, particularly with breathlessness or sweating
Fainting or collapse
Severe breathlessness at rest
Atrial flutter is diagnosed by recording the heart rhythm, and the tests also look for the cause.
1. ECG
A 12-lead ECG shows the characteristic “sawtooth” flutter waves, most clearly in the inferior leads, at an atrial rate of around 300 per minute. Expert reporting helps to distinguish flutter from other fast rhythms.
2. Extended rhythm monitoring
Because flutter can come and go, cardiac monitoring over days or weeks can capture episodes and measure how often they occur.
3. Echocardiogram
An echocardiogram assesses the size of the atria, heart function and valves, and looks for underlying structural disease.
4. Blood tests
Thyroid, kidney and liver function, electrolytes and blood count are checked, and a stress or exercise test may be used if coronary disease is suspected.
5. Electrophysiology study
If ablation is planned, a specialist catheter study maps the flutter circuit and treats it during the same procedure.
Management has three goals: preventing stroke, controlling the heart rate and restoring normal rhythm, and treating contributing conditions.
1. Stroke prevention
Anticoagulation is recommended according to the same risk scores as for AF (such as CHA₂DS₂-VASc), and is generally needed even if you have only atrial flutter
DOACs (apixaban, edoxaban, rivaroxaban, dabigatran) are preferred to warfarin for most people
Anticoagulation is also required for several weeks around cardioversion or ablation, and often continued afterwards depending on your risk
2. Rate and rhythm control
Rate-control medicines (beta-blockers, diltiazem, verapamil or digoxin) slow the ventricular rate, though flutter is often harder to rate-control than AF
Cardioversion (an electric shock under sedation, or sometimes a medicine) restores normal rhythm and is highly effective for flutter
Rhythm-control medicines are less effective for flutter and carry side effects, so are often avoided in favour of ablation
3. Catheter ablation
Catheter ablation of the cavotricuspid isthmus cures typical atrial flutter in over 90% of people and is recommended in preference to long-term drug treatment for most people with symptomatic flutter. The procedure is done by threading catheters through the groin veins, and usually requires one day in hospital. Atypical flutter can also be ablated but is more complex.
4. Treat the underlying condition and AF risk
Control of blood pressure, weight, alcohol, sleep apnoea and heart failure reduces recurrence. Many people with typical flutter develop AF later, so continued review is needed.
Take anticoagulants exactly as prescribed and never stop them without advice. Carry an anticoagulant alert card.
Learn to check your pulse and report a sustained fast regular rate.
Keep alcohol low, stay active and maintain a healthy weight.
Check over-the-counter painkillers, because anti-inflammatories raise bleeding risk with anticoagulants.
After ablation: most people return to normal activity within a few days to a week, and a follow-up ECG or monitor checks the result.
Regular reviews check your stroke and bleeding risk, kidney function and medicines.
Driving: DVLA rules depend on your symptoms. Discuss with your cardiologist.
Support is available from the Atrial Fibrillation Association, the British Heart Foundation and the NHS.
Atrial flutter is often curable. After ablation of typical flutter, over 90% of people are free of flutter long-term.
Many people with flutter also develop atrial fibrillation over time, so continued monitoring and stroke-risk assessment matter even after a successful ablation.
With appropriate anticoagulation, the stroke risk is substantially reduced.
Untreated, prolonged fast flutter can weaken the heart (tachycardia-induced cardiomyopathy), which is usually reversible when the rhythm is corrected.
Outlook depends on the underlying heart condition and how well risk factors are controlled.
Atrial flutter is a fast, regular rhythm arising in the upper chambers of the heart, often giving a pulse of about 150 per minute.
It is closely related to atrial fibrillation and carries a similar stroke risk.
An ECG shows the sawtooth pattern, and monitoring may be needed to capture it.
Anticoagulation is guided by the CHA₂DS₂-VASc score, as in AF.
Catheter ablation cures typical flutter in more than 90% of people.
Cardioversion can restore normal rhythm quickly.
Many people with flutter later develop AF, so follow-up is important.
Underlying causes such as high blood pressure, sleep apnoea and heart failure should be treated.
Guidelines and sources
This page follows current UK and European guidance:
Van Gelder IC et al. 2024 ESC Guidelines for the management of atrial fibrillation. European Heart Journal 2024;45:3314-3414.
Brugada J et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia. European Heart Journal 2020;41:655-720.
These are the questions patients most often ask about atrial flutter.
What is atrial flutter?
A fast, regular heart rhythm arising in the upper chambers of the heart, usually at around 300 beats per minute in the atria, giving a pulse of about 150 per minute.
What is the difference between atrial flutter and atrial fibrillation?
Atrial flutter is a fast but organised and regular rhythm, while atrial fibrillation is chaotic and irregular. They are related, often occur together, and carry a similar stroke risk.
What are the symptoms of atrial flutter?
A fast regular heartbeat or palpitations, breathlessness, tiredness and light-headedness. Some people have none.
Is atrial flutter dangerous?
It is not usually immediately life-threatening, but it raises the risk of stroke and, if untreated for long, can weaken the heart. Both risks can be reduced with treatment.
Do I need blood thinners for atrial flutter?
Usually, yes, if your stroke risk score is high enough, using the same approach as for AF. Your cardiologist will calculate your risk.
Can atrial flutter be cured?
Typical atrial flutter can be cured in most people (over 90%) by catheter ablation, a one-day procedure. Atypical flutter can also be treated, but success is lower.
How is atrial flutter diagnosed?
By an ECG showing the typical sawtooth pattern, with longer rhythm monitoring if it comes and goes. An echocardiogram and blood tests look for the cause.
Will atrial flutter turn into atrial fibrillation?
It can. Many people with atrial flutter have or later develop AF, so regular review and anticoagulation decisions remain important even after successful ablation.
Can I have a private ECG, monitoring or assessment for a fast heartbeat?
Yes. A telephone, video or face-to-face consultation in Peterborough or Corby can review your symptoms, with ECG reporting, cardiac monitoring and echocardiography arranged as needed.
- Is my rhythm typical or atypical flutter, and do I also have AF?
- What is my stroke risk, and do I need an anticoagulant?
- Am I a candidate for catheter ablation, and what are the benefits and risks?
- Do I need cardioversion?
- Which medicines will control my heart rate?
- What could be causing it, and should I be tested for sleep apnoea or thyroid disease?
- How will I be monitored afterwards?
- What happens if the flutter comes back after treatment?
- Is it safe to exercise, drink alcohol, fly and drive?
- What symptoms should make me seek urgent help?
ECG in atrial flutter: regular, saw-tooth flutter waves.
Image: Andrewmeyerson, Atrial Flutter Unlabeled, Wikimedia Commons. Licensed under CC BY-SA 3.0.
Atrial flutter compared
Normal rhythm: the sinus node fires, the atria contract and the ventricles follow in a steady beat.
Atrial flutter: an electrical circuit in the right atrium loops rapidly, producing a sawtooth pattern on the ECG and often a regular pulse of about 150.
Atrial fibrillation: chaotic electrical activity produces an irregularly irregular pulse.
Ablation: a line of ablation across the circuit (the cavotricuspid isthmus) blocks it and cures typical flutter.
If you have a fast, regular heartbeat, a diagnosis of atrial flutter or fibrillation, you may benefit from a telephone consultation or video consultation, or a face-to-face consultation in Peterborough or Corby for a more comprehensive assessment.
Investigations such as ECG, cardiac monitoring and echocardiography may be recommended.
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Medically reviewed by Dr Salam Salloum, Consultant Cardiologist. Last updated: . This page is for general information and does not replace personal medical advice.