Atrial Flutter vs Atrial Fibrillation
| Feature | Atrial Flutter | Atrial Fibrillation |
|---|---|---|
| Atrial rate | 250–350 bpm (regular) | 350–600 bpm (chaotic) |
| Ventricular rate | Regular (often 150 bpm with 2:1 block) | Irregularly irregular |
| ECG pattern | Sawtooth flutter waves (best seen in II, III, aVF, V1) | No P waves; irregular baseline |
| Symptoms | Often similar: palpitations, breathlessness | Often similar |
| Stroke risk | Similar — anticoagulate by same CHA₂DS₂-VASc criteria | Same |
| Ablation success rate | ~90–95% for typical flutter | ~65–85% for AF |
| Treatment | Rate control + cardioversion ± ablation | Rate/rhythm control; anticoagulation |
Management
- Rate control: beta-blockers, calcium channel blockers (verapamil/diltiazem) — targets heart rate <100 bpm at rest
- Anticoagulation: same CHA₂DS₂-VASc scoring as AF — DOAC if score ≥2 (men) / ≥3 (women)
- Cardioversion: electrical (DC) cardioversion to restore sinus rhythm — high success in flutter
- Catheter ablation: ablation of cavo-tricuspid isthmus (CTI) for typical type 1 flutter — 90–95% cure rate; preferred over long-term medications
Ablation Is Preferred Over Lifelong MedicationUnlike AF, typical atrial flutter has a well-defined anatomical circuit. Catheter ablation of the cavo-tricuspid isthmus is curative in >90% of cases — strongly preferred over lifelong rate-control medication.
Is atrial flutter dangerous?
The main risk is stroke — similar to AF. Patients may also develop heart failure from sustained fast ventricular rate. Importantly, many patients with flutter also develop AF — ongoing monitoring is needed.
How is atrial flutter diagnosed?
12-lead ECG showing regular atrial activity at ~300 bpm with sawtooth flutter waves (best in inferior leads II, III, aVF). Ventricular rate typically 150 bpm (2:1 conduction). EP study confirms anatomy before ablation.
What is cardioversion for flutter?
Electrical cardioversion applies a synchronised DC shock to restore normal sinus rhythm. It has a very high success rate (90%+) in flutter. Patients need anticoagulation before cardioversion if flutter has been present >48 hours.
Can flutter become AF?
Yes — up to 50–80% of patients with flutter develop AF over follow-up, even after successful flutter ablation. This is why anticoagulation continues and cardiac monitoring is maintained long-term.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.