Atrial Flutter?

Hi, can Atrial flutter start without elevation of heart rate? Let say resting hear rate is 65 and I think I'm having Atrial flutter with chest tightness and steady pulse and heart rate doesn't move up at all.

Thanks
Mike

No, atrial flutter always produces tachycardia. In fact, that's part of its definition. You'd need an ECG or at least something like an AliveCor to know what's actually happening during these experiences.

You might find this helpful.

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Carey
No, atrial flutter always produces tachycardia. In fact, that's part of its definition.

I disagree. While the atria will be beating at a high rate and are in tachycardia, the ventricles may not. Just like in afib. People have shared tachograms with me when they are in flutter. Some I've seen have had a 4:1 conduction with a very stable ventricular rate of 75 BPM. The ventricular rate is what you will feel in your radial pulse.

I do agree that an ECG would be very useful.

George

Okay, something like a 4:1 conduction is possible, but it would likely be asymptomatic since flutter is typically quite regular. Flutter someone notices isn't going to be slow.

Hi Folks,
George is right here, while it is true that many, if not most, Atrial flutter episodes tend to be tachycardic ... I have seen plenty even as low as
Even as low as 60bpm to 70bpm and even lower that are still in classic flutter. Especially, this can occur in folks with some degree of AV/node conduction issues that lower their conduction spread between atria and ventricles, as Carey noted above in his last post.

Women tend to be very fast HR ‘flutterers’ (if that is a real word?:-)) But men too can be both very fast and slower flutter folks too. Nevertheless, the typical textbook examples of atrial flutter, both the much simpler to ablate typical CTI right Atrial flutter, and the trickier to address Atypical left atrial flutter, invariably show its high speed manifestation even up to the 250bpm to 270bpm ... even up to 300 range (usually not long before VT/VF happen) in very urgent and highly uncomfortable scenarios.

Shannon

Yes, George is right, but that's academic and we're confusing the matter. My point was that with a slow flutter you're most likely not even going to be aware of it unless someone happens to catch it on ECG because it doesn't come with the flopping fish sensation of afib. Only when the rate is high does it become symptomatic. I had at least 5 separate flutter circuits at various times in the past, each with its own rate, and only the fast ones were easily noticeable. My slowest was 110, and I was only aware of it if I took my pulse; otherwise, it felt perfectly normal and I was unaware of it.

So I think we're kind of muddying the waters here with talk of slow flutter. Mike's description of his symptoms doesn't sound like flutter to me. I wouldn't expect flutter at 65 to be symptomatic at all, or if it is, it would likely be only minimally so. Just because a pulse feels regular doesn't mean the rhythm actually is regular.

I had an EKG showing flutter in the 80s, my normal rate is in 60s/70s. Since then once and a while I'll get flutter. Most of the time when I go out of NSR, it's normal afib.
Nancy

Nancy2 - About low-rate flutter -- During my early escalating bouts of flutter that were long lasting and very intense, I once went to the ER hoping for cardioversion about 4:30 am and to avoid the typical crowded waiting room. I was given various IV treatments and as I watched the monitors, the high rate flutter dropped to lower rate... but still flutter. No mention of ECV which was my intention. I was then told, I was ready to be released and that the EP on call would like to see me in his office across the street after discharge. So about 10 am, I went there and the EP told me that eventually if I kept having the flutter bouts, I'd probably need another ablation. He said nothing about the fact that I was released in low rate a-flutter and it was still active.

Once home, I called the Cleveland Clinic and asked to be seen as soon as possible by one of their EPs and was told to arrive the following morning (Friday). Another ECG and confirmed the low-rate flutter. Very comfortable. The very knowledgeable CCF EP told me thought I'd probably self convert by Monday and to just wait it out. I had been nervous because I was well past the 48-hour limit and was not on a formal anticoag. So, I just took more Nattokinase and plenty of Omega 3's and tried to be calm and positive. The low rate flutter was far easier to tolerate than my typical 220 bpm, so by Monday, I was quite used to it. As I recall, it was mid-morning and I checked my pulse and found it was in NSR.

Until I had my second Natale ablation, I had both types of flutter... slow and comfortable and high rate and virtually debilitating.

Jackie