Atrial Flutter vs. Atrial Fibrillation

Atrial flutter and atrial fibrillation (AFib) are two types of abnormal heart rhythm. Both conditions can make your heart beat too fast -- but in a different way.

AFib is the most common type of heart rhythm problem. About one-third of people who have it also have atrial flutter.

Symptoms like a racing heart and dizziness are common with both conditions. That can make it hard to tell them apart.

Your doctor can test you to find out which heart problem you have. And whether it’s atrial flutter or AFib, treatments can put your heart back into a normal rhythm and prevent other health issues like a stroke.

How Atrial Flutter and AFib Start

Your heart has a built-in electrical system that keeps it beating at a steady pace.

During a normal heartbeat, an electrical signal starts in your heart's upper chambers, called the atria. It makes the atria contract and push blood into your heart's lower chambers, called the ventricles. Then the signal travels down to the ventricles, which contract to push blood out to your body.

The atria and ventricles squeeze and release in a constant pattern to keep your heartbeat even and steady.

In atrial flutter, the impulses don't travel in a straight line from the top of your heart to the bottom. Instead, they move in a circle inside the upper chambers. As a result, your heart beats too fast, but still in a steady rhythm.

In AFib, the electrical signals that travel through the atria are fast and disorderly, which makes them quiver instead of squeezing strongly. This causes the heart to beat too fast and in a chaotic rhythm.

Symptoms

Atrial flutter and AFib don't always cause symptoms. Your doctor might find you have one or the other during a test you get for another reason.

But when they do cause symptoms, they can feel very similar, such as:

  • Your heart flutters or beats too fast or hard, called palpitations
  • Shortness of breath
  • Pain or pressure in your chest
  • Trouble exercising
  • Dizziness or fainting
  • Confusion
  • Tiredness

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How Doctors Diagnose Atrial Flutter and AFib

Your doctor will ask about your medical history and symptoms, and give you a physical exam. She’ll listen to your heart, take your pulse, and measure your blood pressure.

Doctors use many of the same tests to diagnose atrial flutter and AFib.

  • Electrocardiogram (EKG). Your medical team places small patches on your chest to measure the electrical signals in your heart.
  • Echocardiogram (echo). This test uses sound waves to make pictures of your heart. It can find problems with blood flow or damage to your heart muscle.
  • Holter monitor. You wear this portable EKG for 24 hours or more to record your heart rhythms throughout the day.
  • Event recorder. This is another wearable EKG, but it records your abnormal heart rhythms over weeks or months.
  • Blood tests. These tests can check for other possible causes of a heart rhythm problem, such as thyroid disease.

Who Gets AFib or Atrial Flutter?

You're more likely to get the conditions if you've had:

Other problems that can lead to AFib include:

Complications

Atrial flutter and AFib both mean your heart doesn’t pump blood as well as it should. When blood flow slows, clots are more likely to form. If one travels to the brain, it can cause a stroke.

A fast heartbeat also makes the heart muscle weaker over time. This can lead to heart failure -- when your heart can't pump out enough blood to supply your body.

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Treatments

Although atrial flutter and AFib are similar in many ways, there are different treatments for each.

The goal of AFib treatment is to slow your heart rate, control its rhythm, and prevent blood clots. Often, treatment starts with medicines like:

If medicine doesn't work, your doctor might try a procedure like electrical cardioversion -- while you’re asleep, you'll get low-energy shocks to your heart to reset its rhythm. Or, you might need a device like a pacemaker to keep your heart on track.

Doctors can often cure atrial flutter with a procedure called ablation. It uses high-energy radio waves to burn off the tiny areas of your heart that cause the abnormal heart rhythm.

Living With AFib, Atrial Flutter, or Both

An irregular heart rhythm like AFib or atrial flutter can affect how well you can work, exercise, and do other activities. To manage these conditions, follow the treatment plan your doctor prescribes. Medicines and other therapies can help control symptoms, like shortness of breath and palpitations, and lower your odds of having a stroke or heart failure.

It’s also important to eat right. Your doctor or a dietitian can help you plan a healthy diet. If you're overweight, losing some pounds may help you control symptoms.

Exercise can also help you manage your heart rhythm. Ask your doctor what types of activities are safe for you, and how to get started in a new program.

WebMD Medical Reference Reviewed by James Beckerman, MD, FACC on April 30, 2018

Sources

SOURCES:

American College of Cardiology: "Living with AFib: Experts and Patients Share 10 Tips."

British Heart Foundation: "What's the difference between atrial flutter and atrial fibrillation?"

Cedars-Sinai: "Atrial flutter."

Cleveland Clinic: "Atrial Fibrillation (AFib): Management and Treatment."

Harvard Medical School: "Ask the doctor: Atrial fibrillation vs. atrial flutter."

Heart Rhythm Society: "Atrial Flutter," "Risk Factors for Atrial Fibrillation (AFib)."

Mayo Clinic: "Atrial fibrillation: Diagnosis & treatment," "Atrial fibrillation: Symptoms & causes."

National Heart, Lung, and Blood Institute: "Atrial Fibrillation."

NYU Langone Health: "Diagnosing Atrial Fibrillation & Atrial Flutter in Adults."

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