What happens when fluttering
Unlike chaotic fibrillation, in flutter the impulse moves in a stable loop - most often around the tricuspid valve in the right atrium. The atria contract very often and equally, and the atrioventricular node, playing the role of a filter, passes every second, third or fourth impulse to the ventricles. Hence the typical picture: the correct pulse is about 150, 100 or 75 beats per minute. In this case, the mechanical work of the atria is almost absent, the blood stagnates in them, and conditions are created for the formation of a blood clot - the main source of danger in this arrhythmia.
- Sustained circular wave of excitation in the atrium
- Regular but rapid pulse
- Typical fluttering is around the tricuspid valve
- Atypical - after operations and ablations, around scars
- Stagnation of blood in the atrium and the risk of thrombus
Causes and risk factors
Flutter rarely occurs in a healthy heart. More often it develops against the background of prolonged arterial hypertension, coronary artery disease, valve defects, cardiomyopathies and heart failure, when the atria are dilated and changed. Chronic lung diseases and sleep apnea, thyrotoxicosis, alcohol abuse, obesity and diabetes mellitus contribute to arrhythmia. A separate group is patients after heart surgery and after ablation for atrial fibrillation: scars create new paths for the circular wave. Episodes can be triggered by infections, dehydration, and electrolyte disturbances.
- Arterial hypertension
- Coronary heart disease and valve defects
- Heart failure
- Chronic lung disease and sleep apnea
- Thyrotoxicosis
- Alcohol abuse, obesity, diabetes
- Previous heart surgeries
Symptoms
Manifestations depend on the frequency of ventricular contractions. At a high frequency, there is a feeling of palpitations, shortness of breath with light exertion, weakness, dizziness, chest discomfort, and decreased tolerance for usual activities. At a frequency close to normal, a person may not feel the arrhythmia for months, and it is found by chance on an ECG. Prolonged fluttering at a high frequency gradually weakens the heart muscle and leads to heart failure with swelling of the legs and shortness of breath while lying down. The most dangerous manifestation is a stroke, which can be the first sign of arrhythmia.
- Rhythmic rapid heartbeat
- Shortness of breath and fatigue on exertion
- Weakness and dizziness
- Discomfort or heaviness in the chest
- Swelling of the legs over a long period of time
- Sometimes completely asymptomatic
Diagnostics
The diagnosis is made by ECG: characteristic sawtooth flutter waves in certain leads are recognized quite reliably. If arrhythmia comes in episodes, daily or longer monitoring is prescribed. EchoCG is needed to assess the size of the atria, the functioning of the ventricle, the condition of the valves and to exclude a thrombus; when planning rhythm restoration without long-term anticoagulation, a transesophageal study is performed. Be sure to check thyroid hormones, hemoglobin, electrolytes and kidney function - the choice and dose of an anticoagulant depends on it.
- 12-lead ECG
- Daily ECG monitoring
- EchoCG
- Transesophageal echocardiography to exclude thrombus
- TSH and thyroid hormones
- Creatinine and kidney function calculation
- Stroke risk assessment using doctor's scale
Treatment
Treatment is based on three tasks. The first is stroke prevention: if there is an increased risk, anticoagulants are prescribed, and they must be taken constantly, regardless of whether arrhythmia is felt or not; Regular aspirin is not suitable for this purpose. The second is to control the frequency of ventricular contractions with drugs that slow down conduction. The third is rhythm restoration: this is done by electrical cardioversion or medications, always observing the rules of anticoagulation before and after the procedure. For typical flutter, catheter ablation of the isthmus in the right atrium is highly effective and often becomes the method of choice already at the first visit.
- Anticoagulants to assess stroke risk
- Rate control drugs
- Electrical cardioversion according to indications
- Catheter ablation of the cavotricuspid isthmus
- Treatment of hypertension, apnea, thyrotoxicosis
- Losing weight and quitting alcohol
- Regular monitoring by a cardiologist
