Atrial flutter (AFL) is a type of abnormal heart rate, or arrhythmia. It occurs when the upper chambers of your heart beat too fast. When the chambers in the top of your heart (atria) beat faster than the bottom ones (ventricles), it causes your heart rhythm to be out of sync.

Atrial flutter is a similar condition to the more common atrial fibrillation (AFib).

Typically, a person with AFL doesn’t feel the fluttering of their heart. Symptoms often manifest in other ways. Some of them include:

  • fast heart rate
  • shortness of breath
  • feeling lightheaded or faint
  • pressure or tightness in the chest
  • dizziness or lightheadedness
  • heart palpitations
  • trouble doing everyday activities because of fatigue

Stress also raises your heart rate, and can exacerbate symptoms of AFL. These symptoms of AFL are common in many other conditions. Having one or more of these symptoms isn’t always a sign of AFL. Symptoms often last for days, or even weeks, at a time.

A natural pacemaker (the sinus node) controls your heart rate. It’s located in the right atrium. It sends out electrical signals to both the right and left atria. Those signals tell the top of the heart how and when to contract.

When you have AFL, the sinus node sends out the electrical signal. But part of the signal travels in a continuous loop along a pathway around the right atrium. This makes the atria contract rapidly, which causes the atria to beat faster than the ventricles.

A normal heart rate is 60 to 100 beats per minute (bpm). People with AFL have hearts that beat at 250 to 300 bpm.

Several things can cause AFL. These include:

Coronary artery disease

Heart disease is a major cause of AFL. Coronary artery disease (CAD) occurs when the arteries of the heart become blocked by plaque.

Cholesterol and fats that stick to the artery walls cause plaque. This slows or prevents blood circulation. It can damage the heart’s muscle, chambers, and blood vessels.

Open-heart surgery

Open-heart surgery may scar the heart. This can obstruct electrical signals, which can lead to an atrial flutter.

Risk factors for AFL include certain medications, existing conditions, and lifestyle choices. People who are at risk for atrial flutter tend to:

  • smoke
  • have heart disease
  • have had a heart attack
  • have high blood pressure
  • have heart valve conditions
  • have lung disease
  • have stress or anxiety
  • take diet pills or certain other medications
  • have alcoholism or binge drink frequently
  • have had recent surgery
  • have diabetes

Doctors start to suspect AFL if your heartbeat at rest goes above 100 bpm. Your family history is important when your doctor is trying to diagnose AFL. A history of heart disease, anxiety issues, and high blood pressure can all affect your risk.

Your primary care doctor can diagnose AFL. You may also be referred to a cardiologist for testing.

Several tests are used to diagnose and confirm AFL:

  • Echocardiograms use ultrasound to show images of the heart. They can also measure the flow of blood through your heart and blood vessels.
  • Electrocardiograms record the electrical patterns of your heart.
  • EP (electrophysiology) studies are a more invasive way to record heart rhythm. A catheter is threaded from the arteries of your groin into your heart. Electrodes are then inserted to monitor heart rhythm in different areas.

Your doctor’s main goal is to restore your heart rhythm to normal. Treatment depends on how severe your condition is. Other underlying health problems can also affect AFL treatment.


Medications can slow or regulate your heart rate. Certain medications may require a brief hospital stay while your body adjusts. Examples of these medications include calcium channel blockers, beta-blockers, and digoxin.

Other medications may be used to convert the atrial flutter rhythm back to a normal sinus rhythm. Amiodarone, propafenone, and flecainide are examples of these types of medications.

Blood thinners, such as non-vitamin K oral anticoagulants (NOACs), can be used to prevent clot formation in your arteries. Clotting can cause a stroke or heart attack. People with AFL have an increased risk of blood clots.

Warfarin has been the traditionally prescribed anticoagulant, but NOACs are now preferred because they don’t need to be monitored with frequent blood tests and they have no known food interactions.


Ablation therapy is used when AFL can’t be controlled through medication. It destroys the heart tissue that’s causing the abnormal rhythm. You may need a pacemaker after this surgery to control your heartbeat. A pacemaker can also be used without ablation.

Alternative therapies

Cardioversion uses electricity to shock the heart’s rhythm back to normal. It’s also called defibrillation. Paddles or patches applied to the chest induce the shock.

Medication is often successful in treating AFL. However, the condition can sometimes reoccur after treatment depending on the cause of your AFL. You can lower the risk of recurrence by reducing your stress and taking your medications as prescribed.


What are the best preventive measures I can take to prevent developing AFL?

Anonymous patient


Atrial flutter is an uncommon arrhythmia but is associated with certain medical conditions such as heart failure, heart disease, alcoholism, diabetes, thyroid disease, or chronic lung disease. The best way to prevent atrial flutter is to try and avoid developing these medical conditions in the first place. Maintaining a healthy lifestyle with a well-balanced diet and regular exercise, refraining from too much alcohol, and quitting smoking if you smoke will help.

Elaine K. Luo, MDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.