Atrial Flutter vs. Atrial Fibrillation

What is atrial flutter, and what is atrial fibrillation (definitions)?

Are atrial flutter, atrial tachycardia, and atrial fibrillation the same thing?

What are the differences in how atrial flutter and AFib affect the heart (ECG wave strip patterns)?

ECG of the Abnormal Conduction of the Hear'ts Electrical System in AFib 

ECG strip showing abnormal wave pattern of atrial fibrillation

Picture of the heart's abnormal electrical conduction in AFib

Picture of the Heart's Abnormal Electrical Conduction in AFib

Both heart diseases have the potential of becoming serious. However, many doctors and other health care professionals consider atrial flutter to be less serious than atrial fibrillation because flutter symptoms tend to be less severe and flutter waves have a less risk of embolization (clot formation). In addition, flutter waves also tend to revert back to sinus rhythm spontaneously more often in some patients.

The difference between atrial flutter and AFib in terms of feeling are very similar. However, if the person can have someone (or even themselves) feel a pulse, if the pulse is regular even though it's fast, the problem is probably atrial flutter. If the pulse is fast and irregular, then the person is more likely to have AFib.

Although some people have no symptoms and cannot feel the arrhythmias, common clinical symptoms of both arrhythmias are:

• Palpitations (person feels their heart beating or pounding)
• Fatigue
• Shortness of breath
• Feeling like you going to faint
• Blurry vision
• Lightheadedness
• Heart skipping beats

Serious symptoms may include the following:

• More severe shortness of breath
• Sweating
• Chest pain
• Fainting or loss of consciousness

Any damage to the healthy electrical pacemaker in the heart's right atrium or left atrium may result in flutter or fibrillation QRS waves. No one knows for sure what triggers either atrial flutter or AFib. However, many doctors and other health care professionals suggest that the risk factors for these two arrhythmias are essentially the same and function as probable causes of the two heart problems. Unfortunately, there are many risk factors for flutter and fibrillation:

• Hypertension (high blood pressure)
• Diabetes
• Heart failure
• Obesity
• Any serious acute illness (myocardial and/or ischemic heart disease, cardiomyopathy)
• Advanced age
• Recent surgery
• Chronic lung disease
• Binge alcohol intake or continual heavy alcohol use
• Hyperthyroidism
• Stress
• Wolff-Parkinson-White syndrome (20% may develop flutter and 7% may develop fibrillation)

In general, because these two arrhythmias are similar in their potential causes, the American Heart Association suggests the same treatment guidelines for both AFib and atrial flutter. The goal of any of these treatments is to return the heart to a normal condition, removal of signals to generate the arrhythmias.

In some individuals, vagal maneuvers like bearing down to have a bowel movement or administration of an IV dose of adenosine may stop atrial flutter. They do not work well for treatment or conversion or stoppage of AFib. However, other medications and procedures are virtually identical (dosage may vary) for treatment of flutter and fibrillation according to the American Heart Association. Medications include antidysrhythmics and beta blockers. Anticoagulants are used prevent blood clots (thromboembolic problems).

Procedures include electrical cardioversion, ablation (radio wave ablation, laser ablation, freezing ablation techniques) of abnormal atrial tissue generating electrical impulses and other surgical techniques such as generation of scar formation (Maze procedure) to block or eliminate abnormal P wave or irregular QRS complex formation in some individuals that are refractory to more common treatments.

Unfortunately, these two problems are difficult to prevent because there are so many potential causes and risk factors associated with them. Some risk factors you cannot change; for example, age over 60, family members with one of the conditions, and being a white male. However, most organizations like the American Heart Association publish suggestions to reduce risk, which include:

• Get regular physical activity.
• Eat a heart healthy diet, low in salt, saturated fats, trans fats, and cholesterol.
• Avoid excessive amounts of alcohol and caffeine.
• Don't smoke.
• Maintain a healthy weight.
• Treat underlying diseases like high blood pressure, sleep apnea, hyperthyroidism, diabetes, or any disease of the heart (especially heart attack, heart valve disease or heart failure).
• Individuals with risk factors they cannot change are especially encouraged to reduce risk by following these suggestions.

The prognosis and life expectancy for patients with atrial flutter or atrial fibrillation depends on the patient's underlying condition. Individuals with complicated medical conditions and poor response to medications or procedures have a poorer prognosis. Patients with atrial flutter may have slightly better prognosis than patients with atrial fibrillation. However, patients with either arrhythmia that undergo ablation have an excellent prognosis with a very low recurrence rate. Ablation can allow a patient to have a normal rhythm with a normal ventricular rate (normal heart rate) and a return to normal heart health.