Difference between flutter and af

[Elli86]

I’ve seen a few posts where people mention AF and also mention flutter. Can someone explain the difference between them? Mainly what the difference feels like. I’m think I may have experienced both myself which is why I’m interested. Seems to feel different when I’ve gone into what I thought was AF while taking medication. I’m now thinking this may be what you guys are calling flutter?

[jeanjeannie50]

Hi Elli, the same question was asked a few days ago and answered fully. Please click here to view:healthunlocked.com/afassoci....

[Elli86 in reply to jeanjeannie50]

Thanks Jean I’ll check that out

[Ppiman]

In my experience, I couldn't feel either in the way of sensing what was going on in the actual heart (i.e. in its atria or top chambers). I have read that some people say that they can feel this but I was told that there are no sensory nerves there to pass on any sensations. What we can feel, I was told, is the pulse, which comes not from the atria at the top, but the ventricles at the bottom of the heart, the two muscles that pump the blood to the lungs and the body. This is felt in certain parts of the body where it is strong enough to affect sensory nerves.

Atrial flutter (AFl) was the major arrythmia that I first had in the spring of 2019. This is a regular beat or "flutter" in the top right muscle or atrium of the heart, which beats too quickly at a fixed 300bpm. It causes the pulse (i.e. the ventricular heartbeat produced from the base of the heart) to be too fast, causing tachycardia of 150bpm.

The flutter caused me to feel completely debilitated with tiredness, light-headedness, feelings of faintness (syncope), chest discomfort and anxiety. Only adding digoxin (125mcg) to my bisoprolol managed to bring my pulse safely down to less than 100bpm. The drugs also, however, lowered my pulse and blood pressure too far. Which of my symptoms were down to the flutter, and which were caused by the effects of the drugs or the terrific levels of anxiety, I shall never know.

After my ablation, the AFl was cured but on stopping the drugs, I then had an attack of what turned out to be persistent atrial fibrillation (AFib). In this, the top left atrium vibrates irregularly. The feelings I had were identical to the flutter. Luckily, a single dose of bisoprolol returned my heart to normal rhythm and I stayed well until last November, when I had a couple of bouts of tachycardia and extreme fatigue. Whether I had Afib, also, I can't know but my Apple watch reported "inconclusive". Luckily, these responded to rest and a dose of bisoprolol. I was supposed to be given a 24-hour monitor but with covid-19 affecting the health system so badly, I have heard nothing more.

Steve

[KMRobbo in reply to Ppiman]

Hi i believe you have misstated - the Afib is LEFT atria.A flutter is normally right atria but can occur fairly rarely in the left atria.

Not medically trained but I have had ablations for both, PVI cryo in left atria, RF in right atria.

I was asymptomatic in high rate afib . I have been running at 243bpm no issues other than the scary high rate.

My A flutter was 140 bpm rate controlled by the 200mg diltiazem I was taking. I was reasonably comfortable lying down, but walking into the kitchen to make a brew had me very breathless. Walking further had me gasping.

But what I have learned from this forum is we are all different in how afib certainly affects different people.

Your pulse that you check is the beat of the left ventricle as that is what moves the blood around your body. The right ventricle pumps blood through your lungs, and back to the left atria

Cheers .

[Ppiman in reply to KMRobbo]

Whoops - thank you. I’ve edited it. That’s what comes of trying to write a long message on a little phone too early in the morning. 😉

I was told that the symptoms of flutter are often very much worse than those of fibrillation but that it was easier to cure by ablation. I have to say that for me both were both completely debilitating.

My friend has a normal pulse rate but has permanent fibrillation and he tells me he feels fine, noticing it only a little when he walks up an incline.

[Elli86 in reply to Ppiman]

Thanks for the info Steve. That’s a lot to dissect but I will be doing so.

Looking at your symptoms they seem extremely similar to mine. The word debilitating is most definitely how I would sum it up also. What age were you when you had your ablation?

[Ppiman in reply to Elli86]

Hi ElliIt was in June 2019, when I was still young at 65! 😉

I wrote a bit of log of my symptoms and progress in posts here at that time which you can search, easily, I believe. I know several people have found them useful to relieve some of the fear that this blessed condition creates.

One thing I was told that helped me a lot was that the arrhythmias in themselves won’t damage the heart, but that persistent tachycardia can (i.e. the fast heart rate that the arrhythmias can cause). In my case persistent tachycardia seems to have caused a tiny leak in one valve and a weakening of my heart’s output - both of which were shown to have returned to normal on a stress MRI scan a couple on months after the ablation (which I was given as I was still having a kind of breathless feeling after a long walk).

For fibrillation, I was told that there are drugs that can often prevent the arrhythmia, but not for flutter (apart from the more risky amiodarone and similar). That’s why an ablation was said to be the best way forward to treat symptomatic atrial flutter.

I’d add that my GP thinks my stomach issues might have been the root cause, and they haven’t gone away sadly (I have a hiatus hernia and suffer diverticular troubles).

Steve

[Elli86 in reply to Ppiman]

That’s very interesting. As I’ve said in another post I have stomach issues and have had for 9/10 years. I’d definitely agree that this could be a root cause. Do you get a gurgling feeling in your chest? It feels almost like air is escaping.

[Ppiman in reply to Elli86]

Yes, often. The gurgling can be quite weird to feel. I’m currently struggling with nausea, which is one symptom I cope badly with. I get discomfort mostly on the bottom left of my abdomen but for several weeks, it’s been under my left rib and, well, here there and everywhere. I’m hoping it’s the hiatus hernia or the bowel trouble setting that off. There’s often “something” going on to worry me!

Steve

[fabjabfab in reply to Ppiman]

I agree my flutter was much worse, the afib made me feel ‘wrong’ but the flutter triggered dizziness and made me literally stop dead, it felt like my heart was bursting.

[Ppiman in reply to fabjabfab]

I came to recognise that there was such a high level of fear attached to it, too, that in the end I couldn’t be sure just what the physical symptoms were and what it was that the fear was magnifying.

Steve

[Elli86 in reply to KMRobbo]

Jesus! 243bpm. I didn’t even think the heart could sustain that kind of output. That’s some bpm. What was your EP/cardios opinion of this? Were they happy for you to crack on with a rate that high? That sounds crazy to me

[KMRobbo in reply to Elli86]

To be honest I am not sure I ever told them as what I found early on onmy afib was that bit I went running after 7 to 10 minutes running the Afib converted into NSR, so I did not have to go to the hospital. The 243 was during a run and once i noticed it was so high if temporarily stop running until it went down a bit. I was completely asymptomatic even at that rate. Unfortunately the running tricke ceased to work after 20 months which is when I decided to have an ablation. Having said that I have been In my local hospital with up to 195 resting so they did know it went high.

[Elli86 in reply to KMRobbo]

I’m pretty sure if my heart rate currently went that high I would be out cold. I get so light headed and on the verge of fainting and my heart rate doesn’t get anywhere close to that. It’s the actually skipped beats that do me though I think. Not entirely sure. It’s very strange how there are so many people with a huge variety of differing symptoms and different tolerances when the symptoms are similar.

[Ppiman in reply to KMRobbo]

Was this measured on an Apple Watch or similar? If so that these can all initially double a first reading before settling down. A spike in the reading is what to look for.

Steve

[KMRobbo in reply to Ppiman]

Garmin 305 with chestbelt. This was proved accurate on 3 occasions versus an NHS ECG , the firs time at my diagnosis. That was a around 165bpm which was sort of the average of my resting hb when in afib, but it did fluctuate quite a bit from this even in the same attack, up to 195 ish.

[Ppiman in reply to KMRobbo]

That's interesting. Several people have quoted a spike on their watch that isn't a real reading. The Garmin seems a different beast altogether!

Steve

[KMRobbo in reply to Ppiman]

Its a very old watch, ( watch was released 15 years ago, I have had mine 11) with a chest belt. I believe the belt works on two pickups on either side that detect electrical signals. I cant remember how I know that but found it out when I was trying to understand why my wifes fit bit measured approx half the heart rate of the Garmin . The fit bit depends on an optical signal in the wrist and clearly could not cope with 165bpm of random beats! I assume that newer/more expensive technology can read this or they would not sell many Apple watches, but I have never tried one!

[Ppiman in reply to KMRobbo]

I think the Fitbit sounds like the Apple Watch. Mine (a 4) is spot on except for some of the first readings when it exactly doubles the count. I think it’s a known fault but can’t remember where I read that. It’s a super piece of kit but rather overpriced. That said, it does so much and does it really well.

Steve

[Sheross]

Flutter is a fast HR in the atrium that is organized (not beating all over the place) whereas A fib is a disorganized fast HR. I think that’s the only difference. I get flutter and my HR is in the 120-160 range. Both are a stroke risk and make you feel breathless, dizzy, etc. I’ve had 3 ablations but I am still getting episodes but so far they are going away on their own after 10 mins to 2 hours. I’m exploring the link between GERD and flutter because I think it may be a trigger. I’d love to figure out what sets it off!

[Ppiman in reply to Sheross]

I have GORD, too, with a hiatus hernia and symptomatic diverticular problems. My GP feels that these might affect the heart. Certainly, I’ve seen that my stomach can be pushed up against the left side of my diaphragm and cause it to distort and push that against my heart. It even acted like an echo chamber once creating a loud clicking sound.

Steve

[Elli86]

I think forums like these are a good step towards figuring out root causes in the medical community. The more people the better. I’d be more than happy to take part in some sort of study if one was presented to a community like this one. Think it would be hugely beneficial for all of us.

[Palpman]

The most common SVT is the re entry tachycardia or AVNRT.

Typically the pulse from the sinus node gets to the AV node but due to a short circuit some of the electrical charge circles back to the Atrium and fires the Atrials again.

Normally this is a 1:1 ratio A to V.

The P wave can be hidden within the QRS complex or it can appear after it or before it.

My AVNRT ECG shows no P waves in any lead and can be misread as AFIB.

This is easily ablated as the re entry circuit is within the AV node or very near it.

The main problem is that the AV node can be damaged irreparably requiring a pacemaker.