Atrial fibrillation or flutter: MedlinePlus Medical Encyclopedia (2023)

Atrial fibrillation or flutter is a common type of abnormal heartbeat. The heart rhythm is fast and most often irregular.


`When working well, the 4 chambers of the heart contract (squeeze) in an organized way.

Electrical signals direct your heart to pump the right amount of blood for your body's needs. The signals begin in an area called the sinoatrial node (also called the sinus node or SA node).

Atrial fibrillation or flutter: MedlinePlus Medical Encyclopedia (1)

In atrial fibrillation, the electrical impulse of the heart is not regular. This is because the sinoatrial node no longer controls the heart rhythm.

  • Parts of the heart cannot contract in an organized pattern.
  • As a result, the heart cannot pump enough blood to meet the body's needs.

In atrial flutter, the ventricles (lower heart chambers) may beat very rapidly, but in a regular pattern.

These problems can affect both men and women. They become more common with increasing age.

Common causes of atrial fibrillation include:


You may not be aware that your heart is not beating in a normal pattern.

Symptoms may start or stop suddenly. This is because atrial fibrillation may stop or start on its own.

(Video) Atrial Fibrillation vs Atrial Flutter - ECG (EKG) Interpretation - MEDZCOOL

Symptoms may include:

The health care provider may hear a fast heartbeat while listening to your heart with a stethoscope. Your pulse may feel fast, uneven, or both.

The normal heart rate is 60 to 100 beats per minute. In atrial fibrillation or flutter, the heart rate may be 100 to 175 beats per minute. Blood pressure may be normal or low.

An ECG (a test that records the electrical activity of the heart) may show atrial fibrillation or atrial flutter.

If your abnormal heart rhythm comes and goes, you may need to wear a special monitor to diagnose the problem. The monitor records the heart's rhythms over a period of time.

  • Event monitor (3 to 4 weeks)
  • Holter monitor (24-hour test)
  • Implanted loop recorder (extended monitoring)

Tests to find heart disease may include:


Cardioversion treatment is used to get the heart back into a normal rhythm right away. There are two options for treatment:

  • Electric shocks to your heart
  • Drugs given through a vein

These treatments may be done as emergency methods, or planned ahead of time.

Daily medicines taken by mouth are used to:

  • Slow the irregular heartbeat -- These drugs may include beta-blockers, calcium channel blockers, and digoxin.
  • Prevent atrial fibrillation from coming back -- These drugs work well in many people, but they can have serious side effects. Atrial fibrillation returns in many people, even while they are taking these medicines.

A procedure called radiofrequency ablation can be used to scar areas in your heart where the heart rhythm problems are triggered. This can prevent the abnormal electrical signals that cause atrial fibrillation or flutter from moving through your heart. You may need a heart pacemaker after this procedure. All people with atrial fibrillation will need to learn how to manage this condition at home.

(Video) Catheter Ablation Procedure: What is it and how does it help an irregular heart beat?

People with atrial fibrillation will most often need to take blood thinner medicines. These drugs tare used to reduce the risk of developing a blood clot that travels in the body (and that can cause a stroke, for example). The irregular heart rhythm that occurs with atrial fibrillation makes blood clots more likely to form.

Blood thinner medicines include heparin, warfarin (Coumadin), apixaban (Eliquis), rivaroxaban (Xarelto), edoxaban (Savaysa) and dabigatran (Pradaxa). Antiplatelet drugs such as aspirin or clopidogrel may also be prescribed. However, blood thinners increase the chance of bleeding, so not everyone can use them.

Another stroke prevention option for people who cannot safely take these medicines is the Watchman Device, which has recently been approved by the FDA. This is a small basket-shaped implant that is placed inside the heart to block off the area of the heart where most of the clots form. This limits clots form forming.

Your provider will consider your age and other medical problems when deciding which stroke prevention methods are best for you.

Outlook (Prognosis)

Treatment can often control this disorder. Many people with atrial fibrillation do very well with treatment.

Atrial fibrillation tends to return and get worse. It may come back in some people, even with treatment.

Clots that break off and travel to the brain can cause a stroke.

When to Contact a Medical Professional

Contact your provider if you have symptoms of atrial fibrillation or flutter.

(Video) Myxoma, Causes, Signs and Symptoms, Diagnosis and Treatment.


Talk to your provider about steps to treat conditions that cause atrial fibrillation and flutter. Avoid binge drinking.

Alternative Names

Auricular fibrillation; A-fib; Afib


Calkins H, Tomaselli GF, Morady F. Atrial fibrillation: clinical features, mechanisms, and management. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 66.

(Video) Multifocal Atrial Tachycardia - EKG (ECG) Interpretation

Heidenreich PA, Estes NAM 3rd, Fonarow GC, et al. 2020 Update to the 2016 ACC/AHA Clinical Performance and Quality Measures for adults with atrial fibrillation or atrial flutter: A report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. J Am Coll Cardiol. 2021;77(3):326-341. PMID: 33303319

January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons. Circulation. 2019;140(6)e285. PMID: 30686041

Lip GYH, Banerjee A, Boriani G, et al. Antithrombotic therapy for atrial fibrillation: CHEST Guideline and Expert Panel Report. Chest. 2018;154(5):1121-1201. PMID: 30144419

Meschia JF, Bushnell C, Boden-Albala B, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(12):3754-3832. PMID: 25355838

Zimetbaum P. Supraventricular cardiac arrhythmias. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 58.

Review Date 1/9/2022

Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Atrial fibrillation or flutter: MedlinePlus Medical Encyclopedia (9)NIH MedlinePlus MagazineRead more

(Video) 25 year old Synchronized Cardioversion out of Afib RVR


How can I tell if I have atrial fibrillation or flutter? ›

In people with atrial fibrillation, the pulse is usually rapid and is always irregular. In people with atrial flutter, the pulse is usually rapid and can be regular or irregular. The reduced pumping ability of the heart may cause weakness, faintness, and shortness of breath.

Which is worse AFib or a flutter? ›

Atrial Flutter is a less severe heart condition than Afib. A person suffering from Atrial Flutter can, if not treated, effectively develop Afib. The symptoms of Atrial Flutter are less severe and easily controlled as compared to Afib.

What is the difference between heart flutter and atrial fibrillation? ›

In atrial fibrillation, the atria beat irregularly. In atrial flutter, the atria beat regularly, but faster than usual and more often than the ventricles, so you may have four atrial beats to every one ventricular beat.

What is the heart rate for atrial fibrillation and flutter? ›

Your pulse may feel fast, uneven, or both. The normal heart rate is 60 to 100 beats per minute. In atrial fibrillation or flutter, the heart rate may be 100 to 175 beats per minute.

How do you rule out atrial flutter? ›

Electrocardiogram (ECG or EKG).

Wires connect the electrodes to a computer, which displays the test results. An ECG can show if the heart is beating too fast, too slow or not at all. An ECG is the main test for diagnosing atrial fibrillation.

What triggers atrial flutter? ›

What causes atrial flutter? Electrical signals that are too frequent cause atrial flutter, making the upper chambers of your heart contract (pump) too often.

Does atrial flutter ever go away? ›

Sometimes, atrial flutter goes away by itself and no further action is needed. If it persists, your doctor may pursue any of the following treatments: Treatment of any underlying conditions. Catheter ablation — procedure to destroy the errant electrical pathways; performed together with an electrophysiological study.

What is life expectancy with atrial flutter? ›

Does this affect my life expectancy? Most patients with atrial flutter lead an entirely normal life with modern drugs and treatments.

Should I worry about atrial flutter? ›

Although atrial flutter is usually not life-threatening at first, it does limit how well your heart pumps blood. This can cause a clot to form in your heart. If the clot breaks loose, it could lead to a stroke. Over time, atrial flutter can weaken your heart muscle.

Can you have atrial flutter without AFib? ›

People with atrial flutter have a heart rhythm that's more organized and less chaotic than that of atrial fibrillation. Sometimes a person may have episodes of both atrial flutter and atrial fibrillation. People with atrial flutter may not have symptoms.

How do you stop heart flutters? ›

The most appropriate way to treat palpitations at home is to avoid the triggers that cause the symptoms.
  1. Reduce stress. Try relaxation techniques, such as meditation, yoga or deep breathing.
  2. Avoid stimulants. ...
  3. Avoid illegal drugs.
Mar 11, 2022

Does a pacemaker help atrial flutter? ›

The atrial pacemakers terminated many attacks of paroxysmal atrial flutter safely and reliably in a follow-up period ranging from 24 to 60 months (average, 42). No major complications developed.

What heart rate is too high with AFib? ›

The most obvious symptom of atrial fibrillation (AF) is palpitations caused by a fast and irregular heartbeat. A normal heart rate, when you are resting, should be between 60 and 100 beats a minute. In atrial fibrillation, it may be over 140 beats a minute.

What does a fluttering heart feel like? ›

When you have heart palpitations, your heartbeat feels uncomfortable or unusual. You may feel it in your chest, neck or throat. Your heartbeat may feel like it is: racing or beating very fast.

What medication is used for atrial flutter? ›

Antiarrhythmic drug treatment can be used to convert atrial flutter to sinus rhythm. Three drugs—ibutilide, flecainide, and propafenone—have a reasonable expectation of accomplishing this.

What is the best initial treatment for atrial flutter? ›

Evidence suggests that initial administration of calcium-channel blockers, like diltiazem, and beta-blockers, like metoprolol, are the most effective drugs in rate-controlling atrial rhythm disturbance [43].

Do you need blood thinners for atrial flutter? ›

​Treatments for atrial flutter

To prevent a blood clot from forming in your heart, you may be started on a blood thinner medicine. The most common one is warfarin (Coumadin®). Other blood thinners that work as well as warfarin, have a lower risk of bleeding, and don't need regular blood tests are also available.

What is the most common presentation of atrial flutter? ›

Patients with atrial flutter can be asymptomatic or present with symptoms as palpitations, lightheadedness, fatigue, and shortness of breath especially in the presence of rapid ventricular conduction. Decreased exercise tolerance is another symptom that can be present during patient evaluation.

What mimics atrial flutter? ›

Coarse atrial fibrillation may mimic atrial flutter over limited electrocardiogram (ECG) strips. Prolonged recordings will uncover an irregular rate and variation in P wave morphology (as compared to a regular rate and P wave morphology with atrial flutter).

Can you live with heart flutters? ›

Although heart palpitations can be worrisome, they're usually harmless. Rarely, heart palpitations can be a symptom of a more serious heart condition, such as an irregular heartbeat (arrhythmia), that might require treatment.

What is the best sleeping position for heart palpitations? ›

This is because the heart is on the left side of the chest and when lying on the left side the heart is closer to the chest wall. This physical closeness makes skipped and therefore skipped beats may be easier to feel. If you notice heart palpitation when lying down, try lying on your right side to see if this helps.

How can I get my heart back in rhythm naturally? ›

Exercise can improve overall cardiovascular health and help restore the heart's natural rhythm. It can also help reduce stress and anxiety. Cardiovascular exercise helps strengthen the heart, which can prevent or reduce palpitations.
Exercise regularly
  1. brisk walking.
  2. jogging.
  3. running.
  4. biking.
  5. swimming.

What is the newest treatment for AFib? ›

Treating AFib

However, the expert heart care team at Adventist HealthCare White Oak Medical Center now offers a new treatment for AFib, the WATCHMAN™ heart implant. The implant is placed during a one-time, minimally invasive procedure and lowers the risk of bleeding and stroke in AFib patients.

When should I go to the ER for my AFib? ›

AFib episodes rarely cause serious problems, but they'll need to get checked out. If they're uncomfortable or their heart is beating rapidly, call 911 or go to an emergency room. Doctors may use medications or a device called a cardioverter to help their heart go back to a normal rhythm.

What should you not do if you have atrial fibrillation? ›

If you have A-fib , it's also important to know which foods and drinks to avoid. For example, your care provider may recommend that you limit or avoid alcohol. Alcohol can cause health issues in some people. People with atrial fibrillation often take blood thinners to prevent blood clots.

What should blood pressure be with AFib? ›

That implies that a BP of 120–129/80 mmHg might be the optimum BP for patients with AF undergoing hypertension treatment.

Can anxiety cause heart flutters? ›

Anxiety is a very common cause of heart palpitations. Some people experience palpitations only in certain stressful situations, while others have palpitations more frequently.

Can fluttering in chest not be heart related? ›

Usually, palpitations are either related to your heart or the cause is unknown. Non-heart-related causes include: Strong emotions like anxiety, fear, or stress. They often happen during panic attacks.

Can you feel your own heart flutter? ›

Palpitations are characterized as a general or heightened awareness of your own heartbeat – whether it's too fast, too slow, or otherwise irregular. You might feel like your heart is thumping, racing, or fluttering. And you could feel this sensation in your chest or your neck.

Does metoprolol stop atrial flutter? ›

Background: Diltiazem (calcium channel blocker) and metoprolol (beta-blocker) are both commonly used to treat atrial fibrillation/flutter (AFF) in the emergency department (ED).

What drugs should be avoided in atrial flutter? ›

If you have atrial fibrillation (irregular heartbeat) and are on blood thinners to lower your risk of blood clots and stroke, beware of nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include common pain relievers naproxen (Aleve®) and ibuprofen (Advil®).

Which beta blocker is best for atrial flutter? ›

Bisoprolol* or metoprolol succinate are first-choice beta-blockers for patients with atrial fibrillation as they are prescribed once-daily and do not require dose adjustment in patients with renal impairment. Bisoprolol is preferred as it is more cardioselective than metoprolol and may cause more bradycardia.

How can I test myself for AFib? ›

firmly place the index and middle finger of your right hand on your left wrist, at the base of the thumb (between the wrist and the tendon attached to the thumb) using the second hand on a clock or watch, count the number of beats for 30 seconds, and then double that number to get your heart rate in beats per minute.

What does atrial flutter feel like? ›

Symptoms of atrial flutter are similar to those of AFib. They include a fluttering feeling in the chest, heart palpitations, shortness of breath, lightheadedness, dizziness, fatigue, and difficulty exercising.

How can you detect AFib at home? ›

If you suspect you have Afib, checking your pulse can be a simple way to listen in on your heart beat and check for irregularities. To do this, put the index and middle fingers of your right hand on the inside of your left wrist, and feel for a pulse.

How do I know if I am experiencing AFib? ›

The most obvious symptom of atrial fibrillation is heart palpitations – where the heart feels like it's pounding, fluttering or beating irregularly, often for a few seconds or possibly a few minutes.

What is the first drug of choice for atrial fibrillation? ›

Beta blockers and calcium channel blockers are the drugs of choice because they provide rapid rate control. These drugs are effective in reducing the heart rate at rest and during exercise in patients with atrial fibrillation.

What is the first line treatment for atrial fibrillation? ›

Beta-blockers and calcium channel blockers are first-line agents for rate control in AF. These drugs can be administered either intravenously or orally. They are effective at rest and with exertion.

What are the dangers of atrial flutter? ›

What Are the Risks of Atrial Flutter? The main danger with atrial flutter is that your heart doesn't pump blood very well when it beats too fast. Vital organs like the heart muscle and brain may not get enough blood, which can cause them to fail. Congestive heart failure, heart attack, and stroke can result.

Can your heart go in and out of AFib on its own? ›

Occasional (paroxysmal atrial fibrillation).

A-fib symptoms come and go, usually lasting for a few minutes to hours. Sometimes symptoms occur for as long as a week and episodes can happen repeatedly. Symptoms might go away on their own. Some people with occasional A-fib need treatment.

Can you tell if you are in AFib by checking your pulse? ›

Some people with AFib have symptoms such as palpitations, shortness of breath, fatigue, dizziness or light-headedness. Other people with AFib have no symptoms at all. AFib can be detected by checking your pulse.

What is the most common cause of atrial fibrillation? ›

Atrial fibrillation (Afib) is an irregular heart rhythm that begins in your heart's upper chambers (atria). Symptoms include fatigue, heart palpitations, trouble breathing and dizziness. Afib is one of the most common arrhythmias. Risk factors include high blood pressure, coronary artery disease and having obesity.

What heart rate is too low with AFib? ›

your heart rate is consistently lower than 60 or above 100 (particularly if you're experiencing other symptoms of atrial fibrillation, such as dizziness and shortness of breath)

When should you go to the ER for atrial fibrillation? ›

AFib episodes rarely cause serious problems, but they'll need to get checked out. If they're uncomfortable or their heart is beating rapidly, call 911 or go to an emergency room. Doctors may use medications or a device called a cardioverter to help their heart go back to a normal rhythm.


1. Intro to Intra-cardiac Electrograms & the EP Lab
(Dr. Joshua Cooper - Arrhythmia Education)
2. Mitral Valve Prolapse and Regurgitation, Animation
(Alila Medical Media)
3. British Heart Foundation - Your guide to EPS (Electrophysiology) and Ablation, a heart disease test
(British Heart Foundation)
4. Management of Atrial Fibrillation in critically ill patients
5. Wolff-Parkinson-White syndrome (WPW) - causes, symptoms & pathology
(Osmosis from Elsevier)
6. OMI (Occluding Myocardial Infarction) - ECG findings for PCI activation
(Peter Thomsen)
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