Atrial Flutter & AFIB Explained by Dr Gregory Bashian

 

Atrial fibrillation and atrial flutter are two similar cousin rhythm disorders. The approach to them can be similar in many ways, and many patients have both of them.

Thus, we will talk about them together. First, before the treatment of the a-fib or a-flutter, we typically perform tests to see if there are other causes or contributing factors. This may include blood work, an echocardiogram, a sleep study if we're looking for sleep apnea, etc.

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1. What is Atrial Flutter? Atrial flutter occurs when the electrical impulses form a circuit on top of the right atria (upper chambers of the heart), causing it to beat much rapidly than normally at approximately 300 beats per minute (bpm) instead of the normal 60-90 bpm. The impulses

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In atrial fibrillation and atrial flutter, the top chambers of the heart, the atria, are beating very fast and basically quivering. This results in several issues, and we typically think of the treatment strategy as having three parallel approaches.

First, when the atrium is quivering, the blood doesn't move well. When blood lays still, it can form a clot, which can then leave the heart and go to the brain, and thus cause a stroke.

That is the most dangerous thing about this rhythm.

Thus, we look at each patient and we ask ourselves what that patient's risk of stroke is, and what we can do about it.

To decrease the risk of stroke, we typically use aspirin, true blood thinners, or sometimes even a procedure to block off the area of the heart where most stroke-causing clots come from. Not everyone needs true blood thinners.

We use blood thinners when the risk of stroke is higher than the risk of bleeding from the blood thinners. We measure a patient's stroke risk by asking several questions and giving the patient a point for each of the following.

Congestive heart failure, high blood pressure, age over 65, diabetes, vascular disease, and female gender. They get two points for age over 75 or for a prior stroke. If a patient scores one, we consider aspirin or true blood thinners.

Vascular Disease Treatment

If a patient's score is two or greater, we typically recommend true blood thinners. The second part of our approach to treating a-fib and a-flutter is controlling the rate of the bottom, main pumping chambers of the heart, the ventricles.

When the top chambers, the atria, are quivering so fast, they tend to drive the ventricles to pump very fast, as well. Thus, we often use medications that don't necessarily keep you in rhythm but do help slow your heart rate down.