Atrial Fibrillation vs Atrial Flutter
Atrial fibrillation (AF) and atrial flutter are closely related atrial arrhythmias. They frequently coexist in the same patient and may convert from one to the other spontaneously, after cardioversion, or following ablation.
1. Electrical Mechanism
Atrial Flutter
- Single macro‑reentrant circuit (usually right atrium)
- Organised atrial activity (~300 bpm)
Atrial Fibrillation
- Multiple chaotic wavelets
- Commonly triggered by pulmonary veins
- Atrial rates 350–600 bpm
2. ECG Differences
| Feature | Atrial Flutter | Atrial Fibrillation |
|---|---|---|
| Rhythm | Often regular (2:1 block common) | Irregularly irregular |
| P waves | Saw‑tooth flutter waves | No discrete P waves |
| Atrial rate | ~300 bpm | 350–600 bpm |
3. Stroke Risk
Both atrial fibrillation and recurrent atrial flutter increase stroke risk. Anticoagulation decisions use the same CHA₂DS₂‑VASc scoring system.
4. Symptoms
- Palpitations
- Fatigue
- Breathlessness
- Exercise intolerance
- Dizziness
Flutter often produces a more regular pounding rhythm. AF typically produces a completely irregular pulse.
5. Cardioversion Outcomes
| Flutter | AF | |
|---|---|---|
| Acute success | >90% | 80–90% |
| 1‑year recurrence | 10–20% | 50–70% |
6. Ablation Differences
Flutter Ablation
- Cavotricuspid isthmus (CTI) ablation
- ~95% success
- Often curative
AF Ablation
- Pulmonary vein isolation
- 60–80% success (paroxysmal AF)
- More complex; repeat procedures sometimes required
Important clinical point: many patients with flutter later develop AF. Some patients treated for AF may transiently develop flutter. The two arrhythmias are electrically related and often represent different manifestations of the same atrial disease process.
Learn more: Atrial Fibrillation | Atrial Flutter
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