Atrial Flutter and Supraventricular Tachycardia: Your Questions Answered

Arrhythmia

Hello, Doctor.
I have been experiencing palpitations (premature beats and rapid heart rate) since around May of last year.
Initially, it occurred a few times a week, but later it became a daily occurrence (mainly at night, in episodes lasting several hours).
During times of frequent premature beats, I would have 20-30 occurrences per minute.
When my heart rate is rapid, it typically ranges from 140 to 160 beats per minute, occasionally reaching 180, lasting from a few seconds to a few minutes.
In October, I consulted a cardiologist and underwent a 24-hour Holter monitor, blood tests, and an echocardiogram.
The blood tests and echocardiogram results were normal.
The 24-hour Holter monitor recorded premature beats and atrial flutter/supraventricular tachycardia (the doctor mentioned that it is difficult to determine the exact type from the ECG unless an invasive electrophysiological study is performed).
The doctor said it is a benign arrhythmia that does not affect heart function and prescribed Diltiazem Slow Release 100 mg to alleviate symptoms.
I have been taking it for a month now; I still experience some premature beats daily, but the frequency of the rapid heart rate has significantly decreased.
I have the following questions:
1) Besides surgery, are there any methods to distinguish between atrial flutter and supraventricular tachycardia at around 150 beats per minute?
2) Is it possible for the arrhythmia to resolve on its own by changing lifestyle habits without medication? (During the initial period of palpitations, I was drinking tea and alcohol daily and was under significant stress.
I have since reduced my intake considerably, but I still experience palpitations daily to some extent.) (Each time my rapid heart rate occurs, it is triggered by premature beats, so I wonder if modifying my lifestyle to reduce premature beats could significantly lower the frequency of episodes?)
3) What are the long-term side effects of taking Diltiazem?
4) The doctor mentioned that the side effects of the medication are minimal and advised me to continue taking it.
However, while I find the symptoms quite bothersome, I am hesitant about taking medication long-term or for life.
From a medical perspective, do you think it is worth taking medication daily for a benign issue?
5) If I do not take medication for atrial flutter/supraventricular tachycardia, will it increase the risk of worsening (more frequent episodes) or developing atrial fibrillation in the future? Could it lead to other issues, such as stroke (even though I currently do not have any hypertension or other risk factors)?
6) Is atrial flutter common? (From what I have read online, it seems to be uncommon among individuals with normal heart structure?) Thank you, Doctor.

Ms. Chen, 30~39 year old female. Ask Date: 2021/01/20

Dr. Wu Xueming reply Cardiology

Atrial flutter and supraventricular tachycardia are primarily diagnosed through an electrocardiogram (ECG).
If the ECG is not conclusive, an electrophysiological study may be performed.
In terms of treatment, medication is typically the first line of management, along with lifestyle modifications such as avoiding excessive caffeine intake, adjusting daily routines, and engaging in regular exercise.
However, if these approaches do not yield significant improvement, catheter ablation for arrhythmia may be considered.
Diltiazem is effective in reducing heart rate and blood pressure and does not have other serious side effects.

Reply Date: 2021/01/20

More Info

Atrial flutter and supraventricular tachycardia (SVT) are types of arrhythmias that can cause symptoms such as palpitations, rapid heart rates, and sometimes discomfort or anxiety. Your experience with palpitations, particularly the episodes of early beats and rapid heart rates, is not uncommon, and many individuals experience similar symptoms at some point in their lives. Let's address your questions one by one.

1. Distinguishing Atrial Flutter from SVT: While both atrial flutter and SVT can present with similar symptoms, they can often be differentiated through an electrocardiogram (ECG). Atrial flutter typically shows a characteristic "sawtooth" pattern, especially in the inferior leads (known as "F-waves"), while SVT usually presents with a narrow QRS complex and may not have distinct P waves. However, as your physician mentioned, definitive differentiation often requires an invasive electrophysiological study, which can provide more detailed information about the heart's electrical activity.

2. Lifestyle Changes and Arrhythmias: It is indeed possible for lifestyle modifications to help manage and potentially reduce the frequency of arrhythmias. Factors such as caffeine intake, alcohol consumption, and stress can exacerbate palpitations and arrhythmias. Since you've already reduced your tea and alcohol consumption and are managing stress better, you may find that these changes contribute positively to your heart rhythm. Additionally, regular exercise, adequate hydration, and a balanced diet can also support overall cardiovascular health. However, it’s important to note that while lifestyle changes can help, they may not completely eliminate the arrhythmias.

3. Long-term Use of Diltiazem: Diltiazem is a calcium channel blocker that is commonly used to manage heart rate and control symptoms associated with arrhythmias. While it is generally well-tolerated, potential side effects can include dizziness, fatigue, headache, and gastrointestinal disturbances. Long-term use may also lead to a decrease in heart rate, which could be concerning if it becomes too low. Regular follow-ups with your healthcare provider can help monitor for any adverse effects.

4. Long-term Medication for Benign Conditions: The decision to continue medication for a benign condition is often a balance between the benefits of symptom relief and the potential side effects of the medication. If your symptoms are significantly impacting your quality of life, continuing Diltiazem may be justified. However, if you feel that the symptoms are manageable without medication, discussing this with your physician is essential. They can help you weigh the risks and benefits based on your specific situation.

5. Risk of Progression without Medication: While atrial flutter and SVT are often considered benign, there is a possibility that they could lead to more serious arrhythmias, such as atrial fibrillation, especially if left untreated. Atrial fibrillation carries a higher risk of stroke and other complications. However, the likelihood of progression varies among individuals. Regular monitoring and communication with your healthcare provider are crucial to assess any changes in your condition.

6. Prevalence of Atrial Flutter: Atrial flutter is less common than atrial fibrillation, particularly in individuals with structurally normal hearts. It is more frequently observed in older adults or those with underlying heart conditions. In younger individuals, it can occur but is generally less prevalent.
In summary, your symptoms and experiences are valid, and it’s important to maintain open communication with your healthcare provider. They can help guide you through managing your condition, whether through lifestyle changes, medication, or further evaluation if necessary. If you continue to experience significant symptoms or have concerns about your treatment plan, do not hesitate to reach out for further evaluation or a second opinion. Your health and comfort are paramount.

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