Atrial flutter and atrial fibrillation (AFib) both occur when the electrical signals that make your heart chambers contract occur faster than typical.
However, they differ in the organization of electrical activity. Atrial flutter and atrial fibrillation (AFib) are both types of arrhythmias.
Main differences
- 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.
People with AFib or atrial flutter may not experience any symptoms. If symptoms do occur, they
| 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 or 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.
AFib
In AFib, the two top chambers of your heart, or atria, receive disorganized electrical signals.
The atria beat out of coordination with the bottom two chambers of your heart or ventricles. This leads to a rapid and irregular heart rhythm. A typical heart rate is 60 to 100 beats per minute (bpm). In AFib, the heart rate typically ranges from 100 to 175 bpm.
Atrial flutter
In atrial flutter, your atria receive organized electrical signals, but the signals are faster than typical. The atria beat more frequently than the ventricles, up to 300 bpm.
The resulting pulse rate is approximately 150 beats per minute. 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, including:
- previous heart issues such as heart disease, heart attacks, and heart failure, and abnormal valves
- high blood pressure
- birth defects
- chronic lung disease
- recent heart surgery
- misuse of alcohol or drugs
- overactive thyroid
People with a history of atrial flutter also have an increase in the risk of developing atrial fibrillation in the future.
Treatment for AFib and atrial flutter shares the same primary goals: to restore the heart’s typical rhythm and prevent blood clots. Treatment for both conditions may include medications
- calcium channel blockers and beta-blockers to regulate the heart rate
- amiodarone, propafenone, and flecainide to convert the rhythm back to typical
- 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).
Other treatments include:
- Electrical cardioversion: This procedure uses an electrical shock to reset the heart’s rhythm.
- 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 generally considered the most effective treatment for atrial flutter. Still, ablation therapy is typically used only when medications can’t control the condition.
A Watchman device closes the left atrial appendage from a noninvasive approach through the groin. This can be done during an ablation and can reduce stroke risk and allow someone a way off of anticoagulation if they cannot tolerate it. A left atrial appendage device can also be deployed during open-heart surgery.
Both conditions have health consequences if left without treatment, and one is not worse than the other.
Both are similar but AFib has more chaotic, irregular electrical signals. A person can have both.
A person with atrial flutter should engage in heart healthy practices, such as avoiding smoking and excessive drinking, doing regular exercise, and eating a heart-healthy diet.
Both AFib and atrial flutter involve electrical impulses in the heart that are faster than usual. However, there are a few main differences between the two conditions.
Both conditions carry an increase in the 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.