Atrial fibrillation and atrial flutter

Atrial fibrillation (also called AFib or AF) is a quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure and other heart-related complications. Common symptoms are palpitations and a faster or irregular heart rate. Symptoms may come and go periodically, or remain more constant. Atrial fibrillation and atrial flutter are the most common heart rhythm disorder and increase the risk of stroke. The primary treatment is medicine.


The heart is a muscle that constantly works to pump blood to all parts of the body to supply the organs with oxygen. The heart consists of two atria and two ventricles. The atrium supplies the chambers with blood that pumps out blood into the bloodstream.


Normally, the heart rhythm is controlled from the sinus node, which lies in the right atrium and is part of the heart muscle’s electrical conduction system. The electrical impulses cause the muscle to contract and the blood to circulate through the vascular system. The impulses can be altered by certain diseases or by injury. Then the heart beats irregularly and less effectively. This leads to impaired circulation and the risk of heart failure. Atrial fibrillation increases the risk of blood clots forming.


In atrial fibrillation and atrial flutter, the signal systems in the heart have come into disarray. When the heart beats in error it is called arrhythmia and if it beats it too quickly it is called tachycardia. 


Atrial fibrillation may come and go periodically (so-called paroxysmal) or be permanent. When the heart rhythm is disturbed, the heart rate changes. At a normal heart rate, heartbeats are between 60 to 90 beats per minute.


Atrial flutter is less common but resembles atrial fibrillation. The difference is how the heartbeat behaves and feels. Atrial flutter can give both a fast and regular heart rate (about 150 beats per minute) but it can also give a fast and irregular heart rate.


Atrial fibrillation and atrial flutter are unusual in people under 60. There are other underlying diseases that can cause fibrillation or flutter:


  • High blood pressure. 
  • Valvular disease in the heart.
  • Overproduction of thyroid hormone ( hyperthyroidism).
  • Heart failure.
  • Kidney failure.
  • Diabetes, especially type 2.
  • Chronic obstructive pulmonary disease (COPD).
  • High alcohol consumption.
  • Stress on the heart in other serious illnesses.


Atrial fibrillation and atrial flutter may be symptom-free, but the most common symptoms are palpitations and feelings of irregularity in the heart rhythm. Other symptoms associated with atrial fibrillation and atrial flutter include:


  • tiredness
  • impaired energy in physical exertion
  • shortness of breath or difficulty breathing
  • chest discomfort or pain
  • faint
  • weight sensation and swollen bones
  • anxiety

Prevention and protection

Common advice for combating cardiovascular disease and thus atrial fibrillation and atrial flutter, focuses on lifestyle.


  • maintain a good and healthy diet.
  • Control stress.
  • Abstain from stimulating products such as coffee, smoking and alcohol.
  • Regular physical activity.
  • If you are being treated with medicines, it is important that you follow your prescription correctly.


To determine if you have atrial fibrillation or atrial flutter, your doctor may perform several different examinations:


  • Body examination with blood pressure and heart rate measurement.
  • ECG examination that measures the heart’s rhythm and tempo.
  • Long-term measurement – you have a portable ECG that measures cardiac activity for 24 to 48 hours.
  • Mapping lifestyle habits, such as exercise, coffee, tobacco, stress and alcohol.
  • Ultrasound examination of the heart can be done to see how the heart muscle and heart valves work.
  • Blood samples that measure blood value, blood sugar, kidney function and thyroid function.
  • Summary of risk factors, such as previous heart disease, age, diabetes, high blood pressure (CHADS score).


The treatment depends on how severe your problems are. Atrial fibrillation and atrial flutter are treated with drugs that regulate your heart rate and heartbeat. You may also be prescribed blood thinners to prevent blood clots. (A clot can form in the atrium of the heart and continue up to the brain where it can cause TIA attack or stroke).


Electric cardioversion can be used to restore heart rhythm in prolonged atrial fibrillation or atrial flutter, if medication does not help. Then you sleep for a short while and get an electric shock through the chest that will help the heart regain its normal rhythm. Electric cardioversion is prepared and followed up with drug treatment.


Relapse after both drug treatment and electricity cardioversion is common. Then the atrial flicker is considered permanent. In the case of atrial flutter, the result of electrical conversion is often more lasting.


A further possibility of treatment is so-called ablation – a small surgical procedure near the sinus node in the heart.

When to consult a doctor

You should seek care to investigate atrial fibrillation or atrial flutter if you experience a combination of the following symptoms:


  • Palpitation.
  • That your heart beats irregularly.
  • Impaired energy or shortness of breath.
  • Feeling anxious.
  • Sleep difficulties.
  • If you feel constantly tired.
  • Unexplained weight gain.


Seek emergency care if you experience:


  • Powerful chest pain.
  • Respiratory distress.
  • Altered state of consciousness (hallucinations/delusions)

How APPOTEK can help

You can contact us at APPOTEK for help with atrial fibrillation and atrial flutter. A nurse or physician can make an individual assessment based on your symptoms, after which you may be prescribed treatment or referred for further examination. Atrial fibrillation and atrial fibrillation require a physical examination.
Our psychologists can also help if you have been diagnosed and need counselling or support.


Vadym Diadiun, Doctor of Medicine, M.D.