hi all, just trying to learn about and understand the difference between these. At my first and only (up to this point) appointment with consultant recently, I asked him which I had - flutter or AFib. ( A and E had said in April that I ‘seemed to have both or either ??…unsure); The consultant last month said to me, when I tried to get clarity, ‘your ecg today showed flutter’. He then said there is not much difference. In my simple understanding I thought flutter was “easier” to deal with?? Anyway, I suppose I am wondering if anyone can give more information, explain their experiences if they have or present with both? Thanking in anticipation.
flutter or afib… or both: hi all, just... - Atrial Fibrillati...
flutter or afib… or both
Written by
JFJ131
To view profiles and participate in discussions please or .
Read more about...
40 Replies
•
You can have either and both at the same time or each at different times as both can be paraoxysmal ie they come and go of their own accord.
The way to distinguish is that AF is an irregular, irregularity ie: your heart rate will be fast, fast, slow, fast, double fast and is in the Left atria (although you would never be able to feel which atria the Arrythmia is of course!). On an ECG AF is dstinguished as a lack of a P wave - that is the small bump which comes just before the main peak. AFlutter on the other hand, is a regular, irregularity ie: it has a steady heart rate which is a multiple of a normal heart rate ie: a fast heart rate and it is a condition of the right atria - which makes it much easier to treat with ablation. Ablation for AFl is often more successful and can prevent AF from developing. AFl on an ECG has a pattern which resembles a saw.
I can say that Flutter is often more symptomatic, was for me, faster heart rate and can often lead to AF if left untreated. I had a mix of both.
The only way you would know is by reading an ECG which you have at any one time and when you both it can look a bit muddled so needs expert cardiologist to diagnose, although the algorithims which on ecg machines are improving.
If you are new to these arrhythmias I would encourage you to get a referral to a specialist cardiologist - Electrophysiologist who are the electricians of the heart - rather than Cardiologists who deal with cardio vascular issues (plumbers if you like) as soon as possible. Ablation at an earlier stage is more likely to be successful. Unfortunately you may wait a very, very long time on NHS, depending where in UK you live and the helpfulness of your GP, so worth investigating your nearest Arrythmia clinic and seeing if you can get an appointment with an EP privately who works both in NHS and privately.
Lots of information on the AA/AFA website :heartrhythmalliance.org/afa...
1st Ablation fixed my AFl but failed to permanently fix the AF and that seems to be a common theme as quite a few of the drugs used to treat AF don’t seem to help AFl. A warning that very few GPs seem to know much at all about arrhythmias
Many thanks for your comprehensive reply and clear explanation. And i take your point re EP... but the situation is that my GP referred me to a cardiologist and i have seen him once, and now have cardioversion booked for next week. I suppose i am asking - do you know if i request (privately) an EP appointment how this will stand with the cardiologist? What i mean is - i dont want to shoot myself in the foot/agitate the cardiologist. Does that make sense
I'm sure CD would agree that cardiologists wouldn't take offence at all. I started out with a cardiologist and then to an EP as well. I'm on both lists. To book an initial private consultation with an EP,you can book directly or ask your Gp to refer you. Booking yourself is quicker.
Ps some Gps are pretty vague about best treatment options for arrthymia, may not think of an EP.Was never mentioned to me,I found out on here! Xx
If you have no particular EP preference and want to keep in the good books of your cardiologist, I would ask his private secretary which EP they favour; mine has his favourites (which have changed over time) and some years ago now he nearly had a heart attack 🤣 when I said I proposed going to see another EP I had found myself.
I transferred from a cardiologist to a private appointment with an EP at a different hospital. I had no problems and then went on a wait list for an ablation which I had in March this year after waiting 16 months
How did it go? And out of curiosity…did you go back as it were to the original cardiologist for the ablation…what I mean is - did you return or still also under the care of cardiologist after EP consultation, or did involvement end with cardiologist and are you now just under the care of the EP?
My involvement with the cardiologist ceased as soon as I transferred to the EP who performed the ablation. I found him through an article he had about robotic ablation in the Sunday Times, he is a top Professor operating out of Glenfield Hospital in Leicester. I went to see him privately but continue under his care, I see him privately but had the ablation under the NHS, hence the long wait.
My ablation was successful and so far (7 months later) have not had any episodes 🤞The results of a 24 hour monitor show I have occasional premature atrial beats and a couple of runs of tachycardia lasting less than 3 seconds. I don't feel any of this so the EP is really pleased that I am in NSR, long may it continue.
I wouldn't like to go through another ablation as I had this under sedation and it wasn't a nice experience. The recovery was a bit of a rollercoaster as I suffered a fair bit of indigestion and aura migraines for 10 days. I am pleased I had it done though as I couldn't cope with episodes of fast heart rates and AF lasting 36 hours, I was always waiting for the next one so afraid to go on holiday etc.
Interesting …how you found the EP and then progressed from there. All sounds good, and wonderful that you are now episode free! As you say, long may it continue! Thanks for your input/sharing.
As soon as the EP takes you on,cardiologist is irrelevant. Your after care is with them too,I've been with mine since 1917 xsorry don't know why keeps underlining! Xx
HiYou may very well have both as I did! The fact the consultant could only identify flutter may be simply due to AFib not joining the party that day!
You are right,flutter is easier to sort out with a cti line ( like cutting an electrical circuit)
But AFib can be better controlled with either meds,ablation and lifestyle too
Flutter is characterised by a rapid regular beat, and on an ecg, shows a sawtooth pattern.
It might be wise to get referred to an EP or pay privately for initial consultation as they are the best people, specially trained cardiologists.
I have had no flutter at all since my ablation in June 2022. A f still lurking about now and then but much better.
Best wishes ❤️
I would just add you might want to get a Kardia device such as the Kardia 6L model. That way you can document your episodes for EP review. This will give you significantly more dots to connect then an occasional EKG at Doctors office, which may miss one arrhythmia or the other. Once you know what you have, treatment will be more precise.
Jim
Hi Jim...to be honest i purchased a kardia - but just the 1 lead (cheaper one); it always comes up as 'possible atrial fibrillation'; well....having said that, when I first started on the medication (higher dose) it showed a few NSR; i explained this to my cardiologist; he asked i send him pictures of these recordings - to which he replied 'it says sinus rhythm...but it is not that'. So, i was quite disappointed.
mine never now shows as anthing other than 'possible atrial fib'. rather frustrating.
In some cases it's best to forget what Kardia determines, and just show Kardia's EKG to an electrophysiologist.
They tend to be a lot better at analyzing EKG's than a general cardiologist. If you do want to upgrade, the 6L is better at differentiating aflutter from afib. Again, it will not be the analysis that is different, but it will be a more comprehensive EKG for an ep to look at.sometimes Kardia has some very good deals when you want to upgrade if you give them a call.
That said even the best EP's can sometimes have a problem differentiating afib from atrial flutter.
Jim
Hi Jim...to be honest i purchased a kardia - but just the 1 lead (cheaper one); it always comes up as 'possible atrial fibrillation'; well....having said that, when I first started on the medication (higher dose) it showed a few NSR; i explained this to my cardiologist; he asked i send him pictures of these recordings - to which he replied 'it says sinus rhythm...but it is not that'. So, i was quite disappointed.
mine never now shows as anthing other than 'possible atrial fib'. rather frustrating.
I can only tell you about my direct experience which was similar to yours. I went to emerg because I had a super fast even in rate heart beat and counted my heartbeats (fingers lightly on neck). 135 bpm. I was then first diagnosed in hospital emerg on ecg then given bolus dilitazem brought it down and converted to sinus. Emerg doctor wrote on discharge afib and referred to cardiologist. A couple weeks after the first even I went to hospital emerg again, had another episode and felt dizzy. This time different emerg doc who said SVT/Flutter on discharge. Now I was confused. After a wait had appt with cardiologist who told me first flutter (by looking at ecg) then he also said afib. I said which one, he said they can go hand in hand. I was really confused. But then he also said he would refer me to an electrician (EP) which was a good decision. From my own personal experience emerg docs, general practitioners and cardiologists if they are well-trained know not to make assumptions because the different presentation and meds given for AF and AFl or both may be a somewhat of an educated "guess" by them if they don't specialize in understanding heart's rhythms.
If you're looking at an ECG, flutter has a sawtooth type of appearance. Afib is irregular rhythm with no P wave.
Mine is a mixture of both. Also the EPs interpret the ECGs differently than the ECG machines so there can be a difference there. My EP said flutter is easier to deal with during ablation.
Thank for your reply.
It’s quite the reverse. AFl is safer and quicker to ablate but much more resistant to drug therapy. It’s what I started with in 2019. AFl is unique as an arrhythmia as it causes the heart to beat in only a stepwise fixed ratio of the atrial flutter beat, which is ~300bpm. The usual ratio is 2:1, which I had, which meant I was struggling with a persistent pulse of 155bpm. Eventually, 125mcg of digoxin with bisoprolol brought this down to 60bpm (i.e. 6:1 AFl). Then my ablation solved it once and for all, although, within a year or so AF and palpitations came winging my way.
How do you feel with your arrhythmia?
Steve
Hi… for me, I don’t really feel much at all. I feel thumping when turn on left side in bed, and I suppose occasionally I feel a bit fluttery, if you know what I mean…but like anxiety, but nothing too bad, tbh. I do fear starting to get symptoms like other people. Mind you am having some symptoms now since starting on 10 mg bisoprolol!
What is your resting heart rate? I feel physically rather like you do with my current AF. I wouldn't be able to exercise during it, though, as even a brisk walk last week caught me unawares and sent the rate from 85-130bpm up to 180+ and that felt very uncomfortable with chest aching and a need to breathe deeply, along with, as you say, that weird anxiety feeling. I simply had to sit down and hope for the best.
Steve
Hi, my resting heart rate seems to be about 90 or 100, sometimes middle of night is goes to 70’s or upper 60’s. Lot of the time is 110, 120. Hoped the bisoprolol would bring it lower grrrr
You might ask about digoxin which was the only drug that helped me. In atrial flutter, the heart rate is more fixed, I believe. AFl is a right sided atrial arrhythmia, so I wonder where yours originates? Interesting! As it seems you have a persistent one, I’d have thought an ECG would reveal all?
Steve
Yes…interesting indeed. I had ecg before the echo and the cardiologist said ‘your ecg showed flutter’; he did not say anything else about this…just that ‘we need to get your heart rate down’ and went on to say about the bisoprolol’this will bring it down’ which it has to some degree , but as said, not as much as I hoped. But very interesting that you say heart rate is more fixed with flutter.
Re the digoxin, yes, I have seen a few comments and contributions on the forum, yours included , where people have said they saw lowering of rate with addition of digoxin…so… maybe. .? I have cardioversion on 10th October…. So … not sure what happens after that.
I had both flutter and afib. When I was first diagnosed the cardiologist told me I had flutter. When I paid to see an EP he told me afib but possibly flutter as well as clarity on an ECG can be difficult in some people.When I had my ablation on March they dealt with the afib and then I went into flutter so they ablated both. Flutter is easier to deal with a d the success from ablation is higher with flutter
Many thanks…sounds reassuring.
I have both and am now in persistent AF but still get episodes of flutter if I am very stressed. I hate being in flutter and can tell the difference. I recently had cataract surgery which I found very difficult and went into flutter and I bet the consultant didnt realise what they were seeing on the monitor was only half of what my rate was not that we could stop the procedure midway.
Not what you're looking for?
You may also like...
Afib or a flutter?
Hello all, me again! 🤦🏻♀️ Hope you’re all well?
So I saw the cardiologist today. I have nice...
Afib, SVT and atrial flutter
Just wondering how many people have more than one arrhythmia and if they find any easier to deal...
Atrial flutter Not Afib
In 2010 i was told that I had Afib after catching it on a cardiocall machine (think that is what it...
Flutter Procedure
Well, Ive just been to see the cardiologist today and discussed my current wobbles.
From the ECG he...
Difference between Afib and atrial flutter
I’ve been told by my EP that I have shifted from Afib to atrial flutter. I have had a cryoballoon...
Dual ablation for flutter and afib - anyone had this?
Afib/Atrial Flutter at 23 years old
atrial flutter or afib
Flutter vs afib
