atrial fibrillation versus atrial flutter in comparison

Editorial Team / Admin · Aug 21, 2007

atrial fibrillation: http://www.emedicine.com/med/topic184.htm

atrial flutter: http://www.emedicine.com/emerg/topic47.htm

view both: http://www.skillstat.com/flash/ecgsim531.html

al7139, ASN, RN · Aug 24, 2007

It's hard to describe without pictures, but here goes:

A-Fib is ALWAYS an irregular rhythm, sometimes decribed as "Irregularly irregular". Controlled A-Fib is a rate of 100 or less. Uncontrolled A-Fib is a rate greater than 100. When you look at an ECG, there are no P waves, and the PRI cannot be measured. If the pt is symptomatic, they are usually cardioverted. If they are asymptomatic, then they are treated with Dilitiazem, Amiodarone, and/ or a beta blocker. THey are always on anticoagulants to prevent clots in the atria.

A-Flutter is a regular rhythm and rate is usually under 100. There is a classic "sawtooth" pattern showing on ECG. Usually a 2:1 or 3:1 ratio with the QRS complex. There are no P waves and the PRI is not measurable.

Treatment is determined by symptoms. They may be cardioverted, but if asymptomatic, they may not be treated for this.

Hope this helps!

Amy

Pneumothorax, BSN, RN · Aug 24, 2007

It's hard to describe without pictures, but here goes:
A-Fib is ALWAYS an irregular rhythm, sometimes decribed as "Irregularly irregular". Controlled A-Fib is a rate of 100 or less. Uncontrolled A-Fib is a rate greater than 100. When you look at an ECG, there are no P waves, and the PRI cannot be measured. If the pt is symptomatic, they are usually cardioverted. If they are asymptomatic, then they are treated with Dilitiazem, Amiodarone, and/ or a beta blocker. THey are always on anticoagulants to prevent clots in the atria.
A-Flutter is a regular rhythm and rate is usually under 100. There is a classic "sawtooth" pattern showing on ECG. Usually a 2:1 or 3:1 ratio with the QRS complex. There are no P waves and the PRI is not measurable.
Treatment is determined by symptoms. They may be cardioverted, but if asymptomatic, they may not be treated for this.
Hope this helps!
Amy

exactly. *a-fib is the ONLY rhythm that is *irregularly irregular*

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Dinith88 · Aug 24, 2007

It's hard to describe without pictures, but here goes:
A-Fib is ALWAYS an irregular rhythm, sometimes decribed as "Irregularly irregular". Controlled A-Fib is a rate of 100 or less. Uncontrolled A-Fib is a rate greater than 100. When you look at an ECG, there are no P waves, and the PRI cannot be measured. If the pt is symptomatic, they are usually cardioverted. If they are asymptomatic, then they are treated with Dilitiazem, Amiodarone, and/ or a beta blocker. THey are always on anticoagulants to prevent clots in the atria.
A-Flutter is a regular rhythm and rate is usually under 100. There is a classic "sawtooth" pattern showing on ECG. Usually a 2:1 or 3:1 ratio with the QRS complex. There are no P waves and the PRI is not measurable.
Treatment is determined by symptoms. They may be cardioverted, but if asymptomatic, they may not be treated for this.
Hope this helps!
Amy

Actually, just a quick clarification regarding 2 points...

1) 'Irregulary irregular' means a rhythm that is 'irregular' at intervals...rather than constantly irregular. Man, is that confusing or what :). The term is oftened used when assessing a pulse...but can be used in other ways.

2)A-flutter can have a 'variable block', in which case it will be irregular (or even irregularly irregular :) ) Can be just as 'irregular' as a-fib.

The thing about a-fib and a-flutter is that they're very similar. A-flutter is considered a more 'organized' rhythm because you can see an ecg baseline 'saw-tooth' pattern (in classic/text-book examples) which is basically the atria firing/contracting/fluttering...and why many times flutter can be 'regular'. (*Sometimes a 2:1 flutter can resemble a sinus rhythm...the flutter-waves resemble a p-wave and t-wave, or a p-wave and normal t-wave because the 2nd flutter wave is buried in the t-wave...just to make things a bit more confusing*)

In a-fib the ecg baseline is usually 'static-like' which (in a classic-text book way) looks wavy/jagged/fibrillating. There is no pattern to it (which is why it's considered less 'organized' than flutter. (*sometimes the fibrillating baseline is so fine it will appear flat...just to make things a bit more confusing*)

They're both atrial dysrhythmias, and are basically treated the same (rate control, anti-coagulation, and sometimes cardioversion)

NurseCherlove · Aug 28, 2007

Sorry, not to be contrary, but a-flutter is considered a TACHYarrythmia and has a ventricular rate of around 150.

Just FYI.

deeDawntee, RN · Aug 28, 2007

Atrial fib will have many sources of firing from cells in the atria that will be attempting to initiate contraction. (As you know, any cardiac cell can initiate an electrical impulse, in atrial fib numerous cardiac cells are initiating electrical impulses. The big boss, the SA node, is no longer in charge, everybody in the atria is trying to take charge!) That is why there is no contraction of the atria at all, it is just quivering in a kind of state of confusion. The atrial rate can be extremely high. Luckily, the AV node blocks most of these electrical impulses from reaching the ventricles. But what does come through is irregular. Since the atria are no longer contracting as a whole, there is no "atrial kick", (there is no contraction that pushes blood into the ventricles right before the tricuspid and mitral valves close.) So there is a loss in cardiac output. Also, the blood is never really ejected out of the atria and if this goes on for greater than 48 hours, it is very likely that clots have formed. That is why these people are never cardioverted unless they just went into a fib or have been anticoagulated for a good stretch of time. Those clots will get squirted out into the system and cause all sorts of problems.

Atrial flutter is often a transitional rhythm. In flutter there are only a few cells, 2, 3 or 4, that are initiating electrical impulses besides the SA node. It is a more organized rhythm and often it is more well tolerated than fib because cardiac output is usually not effected quite as severely as in fib (although it is certainly still effected).

One can compare atrial fib to ventricular fib and atrial flutter to ventricular tachycardia, in that the electrical impulses and what it does to the muscular system as a whole is similar.

Nightcrawler, BSN, RN · Aug 28, 2007

Sorry, not to be contrary, but a-flutter is considered a TACHYarrythmia and has a ventricular rate of around 150.
Just FYI.

I am not trying to be contrary either, but I respectfully disagree. I have seen a-flutter with a ventricular rate of 30 in a patient who was post inferior MI, so a-flutter is not necessarily a tachy anything.

With a ventricular rate of 150 it is very difficult to tell WHAT rate the patient is actually in, and could be interpreted as anything from SVT to VT.

TachyBrady · Aug 28, 2007

I am not trying to be contrary either, but I respectfully disagree. I have seen a-flutter with a ventricular rate of 30 in a patient who was post inferior MI, so a-flutter is not necessarily a tachy anything.
With a ventricular rate of 150 it is very difficult to tell WHAT rate the patient is actually in, and could be interpreted as anything from SVT to VT.

I agree. The atrial rate in atrial flutter is always between 280 and 320. Therefore the ventricular rate will depend on the rate of conduction, i.e. 2:1, 3:1, 4:1 etc. The ventricular rate will be a multiple of the atrial rate. For example, if you have an atrial rate of 300 with a 3:1 conduction, the ventricular rate will be around 100. In 2:1 condution, the ventricular rate will higher (150) and in 4:1 condution, the rate will be lower (70-80).

hypocaffeinemia, BSN, RN · Sep 3, 2007

help..i just want somebody to explain to me in a very clear and thorough explanation regarding atrial fibrillation and atrial flutter..i do have the idea but i want to find a simple english that my friend will understand clearly...pls do reply ASAP...

Simple answer:

Atrial flutter is one irritated focus firing rapidly.

Atrial fibrillation is multiple irritated foci firing rapidly.

It's way more complicated than that (flutter involves reentrant circuits and such), but this differentiation is a useful base for building knowledge.

Matt (nursing student, but monitor tech/emt for 6 years)

al7139, ASN, RN · Sep 4, 2007

To the folks discussing rate of A-Flutter:

I was taught that the ATRIAL Rate is high (200-400). Is this what you mean when you say rate? I was also taught that the ventricular rate is usually 1/2 to 1/3 the atrial rate, depending on AV conduction ratio. So the rate that is measured on telemetry is the Ventricular rate and is most often 100 or less. Is this correct?

Amy

TachyBrady · Sep 4, 2007

To the folks discussing rate of A-Flutter:
I was taught that the ATRIAL Rate is high (200-400). Is this what you mean when you say rate? I was also taught that the ventricular rate is usually 1/2 to 1/3 the atrial rate, depending on AV conduction ratio. So the rate that is measured on telemetry is the Ventricular rate and is most often 100 or less. Is this correct?
Amy

The majority of flutter rhythms I've seen have been controlled (ventricular rate less than 100). However, there is the occasional rhythm that Dinith mentioned that appears to be a sinus tach but in reality is a 2:1 flutter. The T wave is really a second P wave or the P wave is buried in the T wave. The ventricular rate is around 150.

If you have what looks like 2 P waves for every QRS, i.e. 2:1 conduction, and a ventricular rate of less than 100, you know that it cannot be an atrial flutter because the atrial rate in atrial flutter HAS to be 280 to 320 (some sources vary on the actual range but you are safe to say an average rate of 300 beats per minute). If the ventricular rate is 80 and there are 2 P waves for every QRS, you would times 80 by 2 to equal an atrial rate of 160. This cannot be because the atrial rate in flutter is always around 300.

This is a complicated concept but it can be helpful in rhythm determination.