Atrial Fibrillation vs Atrial Flutter
Atrial Fibrillation and Atrial Flutter are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Atrial Fibrillation vs Atrial Flutter at a glance
- Atrial Fibrillation: Most common sustained arrhythmia: irregularly irregular rhythm with no discrete P waves.
- Atrial Flutter: Macro-reentrant atrial tachycardia with sawtooth flutter waves; treated like AFib for stroke risk.
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Side-by-side comparison
| Feature | Atrial Fibrillation | Atrial Flutter |
|---|---|---|
| At a glance | Most common sustained arrhythmia: irregularly irregular rhythm with no discrete P waves. | Macro-reentrant atrial tachycardia with sawtooth flutter waves; treated like AFib for stroke risk. |
| Classic presentation | Palpitations (most common); Dyspnea, fatigue, exercise intolerance; Lightheadedness, presyncope; rarely syncope; Often asymptomatic — found incidentally on… | ECG: 'sawtooth' flutter waves (negative deflections in II, III, aVF and positive in V1) in typical counterclockwise flutter.; Often more symptomatic than AFib… |
| Workup / key labs | TSH (thyrotoxicosis), CBC, BMP, magnesium; Troponin if ischemia suspected; Coagulation studies prior to anticoagulation | TSH, CBC, BMP, magnesium; Coagulation studies; Troponin if ischemia in differential |
| Imaging | 12-lead ECG: irregularly irregular RR, no P waves, narrow QRS (unless aberrancy/pre-existing BBB); Holter or event monitor for paroxysmal AFib not captured on… | 12-lead ECG — diagnostic when flutter waves visible; 2:1 conduction can hide them (rate 150 should prompt vagal maneuvers or adenosine to unmask); TTE for LA… |
| First-line treatment | Acute rate control (HR <110 at rest is reasonable target; <80 for symptomatic):; • Beta-blocker (metoprolol, esmolol IV) — first-line; • Non-dihydropyridine… | Acute rate control: same as AFib — IV beta-blocker or non-DHP CCB; Anticoagulation: same CHA2DS2-VASc-based decision as AFib (flutter carries equivalent… |
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