AF and Atrial Flutter

As discussed on another thread I have recently had some “quivering” at night for the last 4 nights. The GP said this *could* be atrial flutter. I know roughly what atrial flutter is, but I don’t know what the implications of having PAF and (nightly) atrial flutter are. I’m guessing they are not good.

[Finvola]

Some questions Sam - are you taking Flecainide? Flec can induce flutter. Did you test your pulse during the wobbles - 3:1 ratio Flutter might escape notice, depending on your atrial speed.

[Hidden in reply to Finvola]

I’m on Sotalol. I took my pulse and the rate both manually and on Kardia was my normal morning speed-about 54bpm. The GP said it could be flutter but on looking at the Kardia ECG said it didn’t show flutter. I’ve tried to compare the ECG to my normal one and it doesn’t seem different. I believe it’s possible to post an ECG here but I’m not sure how. The main worry is that this is ongoing and I expect it will happen again tonight. I’m not sure how to react to it given the GP said “I’m not saying you shouldn’t go to A and E”.

[Finvola in reply to Hidden]

The speed of the atria in flutter is typically around 270 at its lowest to about 360/380. If you are having the lowest speed and low conduction of 3:1 then the lowest flutter heart rate would be typically about 90. I don't know if it is possible to have a lower conduction of say 4 or 5 atrial beats to 1 heartbeat - a more expert member might know. It's so difficult when nothing shows up on the Kardia but a heart rate of 54 doesn't sound like flutter. I agree with Jalia re the difficulty some medics have with flutter.

I think your GP may be covering his/her back with the A&E comment but if you are really concerned you need to talk to your cardio - perhaps via his/her secretary?

[Hidden in reply to Finvola]

I’m new to flutter so I am not sure precisely what the conduction rate is. As I understand it you are saying that since the lowest rate of flutter (movement of the atria) has to be at least 270bpm for it to count as flutter, the heart rate would have to be at least 90bpm since the ratio of “flutter” to heart rate is about 3 to 1. You are also saying that you cannot rule out the possibility that ratio could be 4:1? If the latter then, presumably, the heart rate would have to be at least 68 for it to count as flutter? If so that is very important since it does indeed effectively rule out flutter.

[Finvola in reply to Hidden]

I'm remembering what my EP told me about 5 years ago regarding my own Flutter. The conduction rate is the ratio of atrial beats to ventricular beats - ie how many of the atrial signals get down to the ventricles to cause heartbeat. As Buffafly indicated, it is possible to have a low HB if the ratio is 5:1 or 4:1 - most of us seem to be 2:1 or 3:1. This is one of the reasons why Flecainide is mostly accompanied by a beta blocker to stop 1:1 conduction of flutter signals.

[Buffafly in reply to Hidden]

We used to have a member who had permanent AF but when he sometimes got flutter instead (not sure how that works) he used to feel great because it ran at 60BPM.

[Finvola in reply to Buffafly]

Thanks Buffafly - I found some very complex articles which referred to 4:1 and 5:1 conduction so lowish heart rates are possible Sam.

[Jalia]

Having had lots ( too much....) experience of paroxysmal and persistent AF and lots of flutter , I always understood that flutter was a fast rate ( mine certainly was) and shows on the ECG as saw tooth waves. In my experience quite a few medics seem to have difficulty in making a definitive diagnosis of Atrial flutter from ECG s!

[Palpman in reply to Jalia]

A conduction of 4:1 is not uncommon with AFlutter. So a heartbeat of 54 means your Atrials are pumping at 216 pm.

There will be 4 clear P waves between 2 consecutive R waves.

The 2 lead kardia device would probably not pick up the P waves.