Atrial Flutter vs. Atrial Fibrillation (AFib): What You Need to Know About the Differences

Atrial fibrillation (AFib) is a common heart rhythm problem in older adults. Nearly 1 in 4 people will get AFib by the time they reach their 70s and 80s. While atrial flutter is less common, it’s a similar problem. Research shows that 40% of people with a new diagnosis of atrial flutter will develop AFib within 3 years. And without the right treatment, both conditions can lead to stroke.

There’s a lot of overlap between these two conditions. But if you have one of them — or both — it helps to understand how they are similar and how they are different. In this article, we’ll talk about the key similarities and differences of AFib and atrial flutter so that you can better understand what to expect if you have either heart condition.

What’s the difference between atrial fibrillation and atrial flutter?

AFib and atrial flutter are both caused by fast electrical signals in the top chambers of the heart. These chambers are known as the atria. The key difference is that with AFib, there’s no real pattern to the rhythm. In atrial flutter, the rhythm is regular, but very fast.

What causes atrial fibrillation and atrial flutter?

All of the things that increase your risk for AFib may also increase your risk for atrial flutter.

Potential causes and risk factors can include:

• Age over 60

• High blood pressure (hypertension)

• Heart valve conditions like aortic stenosis and mitral regurgitation

• Congestive heart failure

• Diabetes

• Thyroid disease

• BMI over 30

• Sleep apnea

• Alcohol use

• Lung disease, including chronic obstructive pulmonary disease (COPD)

• Family history (especially Northern European descent)

• Heart surgery

• Using stimulant drugs like cocaine or methamphetamine

Atrial flutter is more common than AFib in people with 

• COPD

• Congestive heart failure

• Smoking

And AFib is more common in people with hypertension.

It’s important to note that you don’t have to have any of these risk factors to have AFib or atrial flutter. 

Symptoms of atrial flutter vs. atrial fibrillation

AFib and atrial flutter may cause different symptoms for different people. Usually, they both cause palpitations. But some people won’t notice anything at all, especially if their pulse rate is under 100 beats per minute (bpm). Other times, people may have palpitations that feel like AFib or atrial flutter, but their heart rhythm is actually normal. You can also experience an occasional skipped beat that feels irregular. This is different from atrial fibrillation or flutter, but it can be hard to be sure without an electrocardiogram (EKG) test to look at the heart rhythm.

When you’re in AFib, your heart rate is always irregular. And when you’re in atrial flutter, it might feel more regular. But again, it can be difficult to be sure based on your symptoms alone. Many people with both of these conditions can’t tell the difference between the two.

Symptoms of both AFib and atrial flutter include:

• Heart palpitations or heart racing

• Chest tightness, pain, or discomfort

• Shortness of breath

• Fatigue

• Weakness

• Dizziness

Differences in atrial fibrillation and atrial flutter treatment

The treatments for AFib and atrial flutter are very similar. There’s a wide range of options. The best choice will depend on how frequent and severe the problem is, and what other conditions you have. Often, you will need a combination of treatments. These include:

• Medications to slow the heart, including beta blockers, calcium channel blockers, and digoxin

• Medications known as antiarrhythmics to keep your heart in a normal rhythm

• Blood thinners to prevent stroke, a complication of both conditions

• Cardioversion, a procedure that uses electricity to reset the heart rhythm

• Ablation, a procedure done with a catheter

• Surgery

Atrial flutter is often easier to treat with ablation. AFib may require more medications and procedures to get it under control.

How are atrial fibrillation and atrial flutter diagnosed?

Many times, AFib and atrial flutter are diagnosed after someone notices palpitations. But if you have symptoms of palpitations, it doesn’t always mean that you have AFib or atrial flutter. Your healthcare professional will order an EKG to check your heart rhythm. If it looks normal, you may need more heart rhythm monitoring. This could include:

• A Holter monitor, which is worn for 24 to 48 hours

• An event monitor, which can be worn for up to a month

• A smart watch or other home device 

• A tiny monitor implanted under the skin that can later be removed

Even if you’ve never had symptoms of AFib or atrial flutter, your healthcare professional might suspect these conditions if you’ve experienced:

• Stroke 

• Unexpected heart failure

• Severe fatigue

• Dizziness

• Loss of consciousness

Which condition is more serious: atrial flutter or atrial fibrillation?

Both AFib and atrial flutter can cause a stroke. In both conditions, the abnormal squeezing of the heart can allow blood to collect in the upper heart chambers. This can increase your risk of developing blood clots. 

If this happens, the blood clot can leave the heart and travel toward the brain. This can then block one of the blood vessels in the brain, causing a stroke.

Atrial flutter is a more regular and organized rhythm. That means that blood clots are less likely to form than with AFib. So, you’re more likely to have a stroke with AFib than with atrial flutter. But no matter which condition you have, it’s important to work with your healthcare professional to get the problem under control. They’ll make sure you’re on the right medications to safely reduce your risk of stroke. And they can refer you to a cardiologist for more specialized care if needed.

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Written by:

Sarah A. Samaan, MD

Sarah Samaan, MD, FACC, FACP, FASE is a board-certified cardiologist who practiced clinical cardiology for nearly 30 years. She is a member of the American College of Cardiology and the American College of Physicians, among others.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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