Atrial fibrillation (AFib) and atrial flutter are common types of arrhythmias — abnormal heart rhythms. Because the two conditions share many similarities, it can be hard to tell them apart. Both can cause fatigue, heart palpitations, and a higher risk of stroke, but they affect the heart in different ways.

What Are Atrial Fibrillation and Atrial Flutter?

Both atrial fibrillation and atrial flutter are types of abnormally fast heart rhythms that start in the atria (upper chambers) of the heart. Normally, the heart’s electrical system controls how it beats. These electrical signals help the heart pump blood to the rest of your body in a regular, coordinated way — from 60 to 100 beats per minute at rest.

The most common type of arrhythmia is atrial fibrillation. In AFib, the atria can beat up to 600 times a minute, forcing the heart’s ventricles (lower chambers) to beat as fast as 350 times per minute. Instead of beating in a steady rhythm, the atria fibrillate (quiver or shake), which makes it harder for the heart to pump blood effectively.

Atrial flutter also causes a fast heartbeat, but the rhythm is more regular than with AFib. The atria usually beat between 250 and 350 times per minute, which can push the ventricles to beat up to 150 beats per minute.

Symptoms of Atrial Flutter and Atrial Fibrillation

You might not notice any symptoms with atrial fibrillation and atrial flutter. When symptoms do appear, the most common ones include:

• Heart palpitations (racing or fluttering heart)
• Shortness of breath
• Lightheadedness
• Fatigue (extreme tiredness that doesn’t improve with rest)
• Fainting
• General weakness

• Chest pain

Causes of Atrial Flutter and Atrial Fibrillation

AFib and atrial flutter often have the same root causes. Both usually happen because of weakness in or changes to the heart’s cells and tissue, which may come from:

• High blood pressure
• Coronary heart disease (narrowed or blocked arteries)
• Heart failure (when the heart can’t pump well)
• Hyperthyroidism (an overactive thyroid)
• Congenital heart disorders (heart problems present at birth)
• Heart valve problems

Other factors such as aging, genetics, or infections can also damage the heart.

Risk Factors for Atrial Flutter and Atrial Fibrillation

Risk factors for atrial fibrillation and atrial flutter are generally similar and include:

• Obstructive sleep apnea (a condition that causes breathing to stop and start during sleep)
• Obesity (a medical condition in which a person’s body mass index, a measure of weight relative to height, is 30 or higher)
• Diabetes
• Chronic kidney disease
• Thyroid problems
• Other heart conditions
• Lifestyle habits such as heavy alcohol use and smoking tobacco

One difference between the two conditions is that atrial flutter is more often linked to lung diseases such as chronic obstructive pulmonary disease (COPD), while chronic (long-term) AFib is more often associated with kidney disease. However, either condition can lead to either type of irregular heartbeat.

Regular physical activity usually helps lower the risk of AFib, but too much intense exercise may raise that risk. Also, stressful situations and emotional strain can contribute to AFib. In some people, heart surgery can trigger AFib or atrial flutter.

Diagnosis of Atrial Flutter and Atrial Fibrillation

Both atrial fibrillation and atrial flutter are usually diagnosed with an electrocardiogram (ECG). This test records the heart’s electrical signals and helps doctors see whether your heartbeat is regular or irregular.

In atrial flutter, the heart beats quickly but in a steady pattern. In AFib, the heartbeat is both fast and irregular. On an ECG, AFib looks like uneven, unpredictable heartbeats, whereas atrial flutter shows a rhythm that’s more regular but too fast.

To fully understand what’s going on, your doctor may do a physical examination, review your family’s medical history, and consider any other health conditions you have. They may also order blood tests to check certain electrolytes or thyroid hormone levels or use imaging tests such as an echocardiogram or MRI.

If your doctor suspects atrial flutter, a lung function test might also help confirm the diagnosis.

Treatment for Atrial Flutter and Atrial Fibrillation

Treatment options for atrial fibrillation and atrial flutter are similar. They may include medical procedures or medications. Your cardiologist or another doctor will help you understand which options might be best for you.

Medications

Doctors often use similar types of medication to treat both atrial flutter and AFib. These drugs may include:

• Beta-blockers to slow heart rate
• Calcium channel blockers to help control heart rate
• Anticoagulants (blood thinners) to reduce the risk of stroke
• Anti-arrhythmic drugs to help regulate heart rhythm

The specific medications your doctor recommends will depend on your symptoms and overall health, as well as any other conditions you have.

Procedures

Common procedures for atrial fibrillation and atrial flutter include:

• Electrical cardioversion — A low-energy shock is delivered to the heart to reset its rhythm.
• Catheter ablation — This minimally invasive procedure removes any tissue causing the persistent arrhythmia.

Your cardiologist may recommend other procedures depending on your needs.

Lifestyle Changes

Lifestyle changes are usually recommended along with medications and procedures to help manage atrial fibrillation and atrial flutter. Your doctor may advise you to:

• Manage stress.
• Stay physically active.
• Avoid alcohol, stimulants, and tobacco.
• Eat a heart-healthy diet.

Can You Have Both Atrial Fibrillation and Atrial Flutter?

Yes, it’s possible to have both atrial fibrillation and atrial flutter, though usually not at the same time. Research suggests that about 1 in 5 people with AFib experience episodes of atrial flutter. Also, about 80 percent of people diagnosed with atrial flutter will eventually develop AFib.

Some medications commonly used to treat AFib can trigger atrial flutter. These anti-arrhythmic drugs help keep the heart’s rhythm steady and regular, preventing it from beating too fast or irregularly.

Understanding the differences between these two conditions can help you and your doctor choose the best approach to manage your condition. With the right mix of medications, procedures, and lifestyle changes, many people live well with AFib or atrial flutter — or both.

Talk With Others Who Understand

MyHeartDiseaseTeam is the social network for people with heart disease and their loved ones. On MyHeartDiseaseTeam, members come together to ask questions, give advice, and share their stories with others who understand life with heart disease.

Are you or a loved one living with atrial fibrillation or atrial flutter? How were you diagnosed? Share your experience in the comments below, or start a conversation by posting on your Activities page.