Atrial flutter

Atrial flutter

This is the infamous arrhythmia that affected ther former Prime Minister Tony Blair. It is a very common cardiac rhythm disorder affecting an estimated 900 individuals per million of the population. Atrial flutter is 3 times more common in patients with structural heart disease (enlarged/impaired cardiac function, leaky valves, heart muscle disorders and chronic lung disease). It is associated with a very rapid but regular revolving electrical circuit (300 cycles per minute!) predominantly located in the right atrial chamber of the heart. Atrial flutter results in rapid heart rates, breathlessness, reduced exercise capacity and this condition has a small stroke risk.

In the last decade we have developed a full understanding of this arrhythmia, and now we can offer patients catheter ablation treatment as a definitive cure for this arrhythmia. Atrial flutter is a loop like circuit revolving around the right atrium (Figure 5), spreading out and passing through a narrow channel called the isthmus (Figure 6). By passing a catheter from a vein in the groin under local anaesthesia, this circuit can be successfully cut internally by a moving catheter and rendered these circuits non-functional, providing a “cure” in 95% of cases, with minimal of risk (<1% risk). In fact these cases usually take under an hour to perform and can be done as day cases without the need for an overnight stay. If patients only have flutter, all cardiac rhythm drugs including blood thinners (Warfarin) can be stopped soon after the procedure.

Drugs are generally not very effective when used to terminate or prevent flutter. Although an electrical current can be used to jolt the heart back to normal (DC cardioversion), there is over 50% chance within 2 year of a recurrence of this condition. The Prime Minister also had a cardioversion but developed the same problem within a few months.