How is atrial flutter treated?

Photo of someone taking tablets

Acute atrial flutter can be stopped using a burst of electrical energy. Medication is often used, too. An operation called ablation, which destroys a small amount of heart tissue, is usually recommended as well to stop the atrial flutter from coming back.

The treatment of atrial flutter is made up of several possible parts. The selection of these parts depends on various factors such as whether the atrial flutter is acute at the time, where exactly it has developed in the heart, if it is causing symptoms, and if so which ones.

It is best to talk to your doctor about which treatment makes the most sense in your individual situation. It is important that you understand which specific treatments are an option for you and why. The decision aid about cardiovascular diseases might help. You can also use it to figure out which factors are most important to you.

What should I do if I have acute atrial flutter?

You have had an unpleasant racing heart for hours, and dizziness and faintness are also worrying you, and the ECG done at your doctor's office or at ER shows that you have atrial flutter. The following treatments are then an option:

Restoring the heart's normal rhythm – cardioversion

Doctors usually try to quickly put the heart back into its normal sinus rhythm, especially if the atrial flutter is causing severe circulation problems. This procedure is called cardioversion. Because it uses a burst of electrical energy, it is sometimes also called electrical cardioversion.

You will be given a short-lasting mild anesthetic for the electrical cardioversion. Electrodes that deliver the electrical energy are stuck or pressed onto your chest. This burst of electrical energy stimulates all of the heart muscle cells at once, and they then relax again at the same time. That gets rid of the signals circulating in the atrium that caused the atrial flutter and kept it going. The heart starts beating in its normal rhythm again on its own.

Electrical cardioversion is considered to be very effective and well tolerated, which is why it is the preferred treatment for acute atrial flutter. Side effects such as skin burns are rare. The anesthetic can also have side effects.

Slowing down the heart rate with medication

Using medication to slow down the fast heart rate is an alternative to cardioversion. The medication is injected intravenously to treat acute atrial flutter. This treatment is also called frequency control and is an option if your circulation is stable but you don’t want or can’t have electrical cardioversion, perhaps because you wouldn’t tolerate the anesthetic. Frequency control is sometimes used to bridge the gap until cardioversion can be carried out and to relieve symptoms like a racing heart (palpitations), dizziness and faintness. Beta blockers and channel blockers are especially well suited for this.

But these medications don't stop the atrial flutter, so they don’t reduce the risk of stroke, either, especially if there are other risk factors like old age.

These medications are no longer needed if the heart's rhythm goes back to its normal sinus rhythm either on its own or with cardioversion and is kept there using ablation. If that doesn't work, the medication can still be taken in tablet form over the long term. But this option is usually only recommended if the atrial flutter and high pulse don't have a major effect on your everyday life. The typical side effects of beta blockers may include breathing difficulties, low blood pressure and nausea. The possible side effects of channel blockers include headaches, itching, skin rashes, nausea and other heart rhythm disorders.

Which other options are there in certain situations?

If you already have a defibrillator or pacemaker, the heart’s normal rhythm can also be restored using the implanted device. It is then set to briefly stimulate the heart to an even higher frequency. This “overpacing” stops the atrial flutter. The heart can then continue beating normally again.

It is also theoretically possible to restore the heart’s normal rhythm with medication (cardioversion with medication). Only amiodarone is available for that in Germany. But its cardioversive effect is low, meaning that it can’t reliably restore the heart's normal rhythm. That is why amiodarone is usually only used to slow the heart rate down. Experts only recommend it if other treatment options haven't worked or weren't tolerated. Side effects include trembling, and problems affecting skin, vision, and circulation. Amiodarone can also cause heart rhythm disorders itself and lead to problems with the lungs, liver and thyroid. Pregnant women and people with an overactive thyroid or iodine can't take it.

When are anticoagulants recommended?

Like atrial fibrillation, atrial flutter can also cause blood clots to form in the atria. That can lead to a stroke or pulmonary embolism if the clots pass into the brain or the lungs. Anticoagulants, generally often referred to as blood thinners, can be taken to prevent that. But they increase the risk of bleeding, such as in the digestive tract (stomach and bowel). That is why these pros and cons need to be considered before starting the treatment.

People with atrial flutter and are given anticoagulants as recommended for treating atrial fibrillation. There are not many studies on the use of this treatment for atrial flutter alone, which is why there are fewer specific rules. So treatment with these medications is based on the procedure for and depends on your individual risk of stroke. For instance, experts recommend anticoagulants to treat atrial flutter if an ultrasound scan has detected blood clots in the atria before an electrical cardioversion procedure or if the atrial flutter has already lasted for longer than 48 hours.

Things like your individual risk of a stroke determined whether you need medication, and if so for how long. That risk is especially high if you are over 75 years old and have already had a stroke. High blood pressure, coronary artery disease, heart failure and diabetes are also risk factors. Women have a higher risk of stroke.

How can atrial flutter be stopped from coming back?

A small amount of heart tissue is usually cauterized within a few weeks of cardioversion to prevent atrial flutter in the long term. Doctors insert a thin tube called a into a vein through an incision in the groin. They then push special instruments through the up to the heart. The tissue there is heated up using electricity and then destroyed; in rare cases extreme cold is used instead. Experts call this procedure catheter ablation.

A local anesthetic in the groin and a short, mild anesthetic used while the tissue is being destroyed are typically enough. You will usually stay overnight at the hospital after the procedure. The possible risks are bleeding, stroke, heart rhythm disorders and damage to heart or other tissue. Overall, about 20 out of 1,000 people develop severe complications, and 2 out of 1,000 people die as a result of the procedure.

In typical atrial flutter, the area right between the inferior vena cava and the heart valve that connects the right atrium and the right ventricle is usually destroyed. Experts refer to that small piece of tissue as the cavotricuspid isthmus (CTI). In typical atrial flutter, the stimulating signal repeatedly circles that spot. That is no longer possible if that area is scarred after some of the tissue has been destroyed.

CTI ablation can effectively stop atrial flutter from returning in about 90 percent of people with typical atrial flutter. But , the other, more common heart disorder that occurs in the atrium, can still develop at a later stage.

There are also types of atrial flutter where the narrow part between the vena cava and the heart valve is not involved. That is referred to as atypical atrial flutter. Ablation can help here, too, but the chances of success are lower than for typical atrial flutter. This procedure is normally carried out in a specialist heart clinic. They can check where the abnormal signals are coming from before and during the procedure to work out which parts of the atria have to be destroyed.

Brugada J, Katritsis DG, Arbelo E et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia. The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J 2020; 41(5): 655-720.

European Society of Cardiology (ESC). Deutsche Gesellschaft für Kardiologie - Herz- und Kreislaufforschung (DGK). Pocket-Leitlinie: Supraventrikuläre Tachykardien (Version 2019). 2020.

Kasper DL, Fauci AS, Hauser SL et al. Harrison's Principles of Internal Medicine. New York: McGraw-Hill; 2015.

Page RL, Joglar JA, Caldwell MA et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2016; 67(13): 1575-1623.

Pschyrembel Online. 2022.

Romero J, Patel K, Briceno D et al. Cavotricuspid isthmus line in patients undergoing catheter ablation of atrial fibrillation with or without history of typical atrial flutter: A meta-analysis. J Cardiovasc Electrophysiol 2020; 31(8): 1987-1995.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Comment on this page

What would you like to share with us?

We welcome any feedback and ideas - either via our form or by We will review, but not publish, your ratings and comments. Your information will of course be treated confidentially. Fields marked with an asterisk (*) are required fields.

Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Über diese Seite

Created on June 20, 2023

Next planned update: 2026


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

How we keep you informed

Follow us on Twitter or subscribe to our newsletter or newsfeed. You can find all of our films online on YouTube.