Atrial flutter and atrial fibrillation (AFib) are both types of arrhythmias. They both occur when there are problems with the electrical signals that make your heart chambers contract. When your heart beats, you’re feeling those chambers contracting.
People with AFib or atrial flutter may not experience any symptoms. If symptoms do occur, they are similar:
|Symptom||Atrial fibrillation||Atrial flutter|
|rapid pulse rate||usually rapid||usually rapid|
|irregular pulse||always irregular||can be regular or irregular|
|dizziness or fainting||yes||yes|
|palpitations (feeling like the heart is racing or pounding)||yes||yes|
|shortness of breath||yes||yes|
|weakness or fatigue||yes||yes|
|chest pain or tightness||yes||yes|
|increased chance of blood clots and stroke||yes||yes|
The major difference in symptoms is in the regularity of the pulse rate. Overall, the symptoms of atrial flutter tend to be less severe. There is also less chance of clot formation and stroke.
In AFib, the two top chambers of your heart (atria) receive disorganized electrical signals.
The atria beat out of coordination with the bottom two chambers of your heart (ventricles). This leads to a rapid and irregular heart rhythm. A normal heart rate is 60 to 100 beats per minute (bpm). In AFib, the heart rate ranges from 100 to 175 bpm.
In atrial flutter, your atria receive organized electrical signals, but the signals are faster than normal. The atria beat more frequently than the ventricles (up to 300 bpm). Only every second beat gets through to the ventricles.
The resulting pulse rate is around 150 bpm. Atrial flutter creates a very specific “sawtooth” pattern on a diagnostic test known as an electrocardiogram (EKG).
Risk factors for atrial flutter and AFib are very similar:
|Risk factor||AFib||Atrial flutter|
|previous heart attacks||✓||✓|
|high blood pressure (hypertension)||✓||✓|
|abnormal heart valves||✓||✓|
|chronic lung disease||✓||✓|
|recent heart surgery||✓||✓|
|misuse of alcohol or drugs||✓||✓|
People with a history of atrial flutter also have an increased risk of developing atrial fibrillation in the future.
Treatment for AFib and atrial flutter has the same goals: Restore the normal rhythm of the heart and prevent blood clots. Treatment for both conditions may involve:
- calcium channel blockers and beta-blockers to regulate the heart rate
- amiodarone, propafenone, and flecainide to convert the rhythm back to normal
- blood-thinning medications such as non-vitamin K oral anticoagulants (NOACs) or warfarin (Coumadin) to prevent stroke or heart attack
NOACs are now recommended over warfarin unless the person has moderate to severe mitral stenosis or has an artificial heart valve. NOACs include dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) and edoxaban (Savaysa).
Electrical cardioversion: This procedure uses an electrical shock to reset the rhythm of your heart.
Catheter ablation: Catheter ablation uses radiofrequency energy to destroy the area inside your heart that’s causing the abnormal heart rhythm.
Atrioventricular (AV) node ablation: This procedure uses radio waves to destroy the AV node. The AV node connects the atria and ventricles. After this type of ablation, you’ll need a pacemaker to maintain a regular rhythm.
Maze surgery: Maze surgery is an open-heart surgery. The surgeon makes small cuts or burns in the heart’s atria.
Medication is usually the first treatment for AFib. However, ablation is usually considered the best treatment for atrial flutter. Still, ablation therapy is typically only used when medications can’t control the conditions.
Both AFib and atrial flutter involve faster than usual electrical impulses in the heart. However, there are a few main differences between the two conditions.
- In atrial flutter, the electrical impulses are organized. In AFib, the electrical impulses are chaotic.
- AFib is more common than atrial flutter.
- Ablation therapy is more successful in people with atrial flutter.
- In atrial flutter, there is a "sawtooth" pattern on an ECG. In AFib, the ECG test shows an irregular ventricular rate.
- The symptoms of atrial flutter tend to be less severe than the symptoms of AFib.
- People with atrial flutter have a tendency to develop AFib, even after treatment.
Both conditions carry an increased risk of stroke. Whether you have AFib or atrial flutter, it’s important to get a diagnosis early so you can get the right treatment.