Medically reviewed by Dr Nabila Laskar, Consultant Cardiologist (GMC 7040901). Atrial flutter is a fast heart rhythm arising from the upper chambers of the heart. It carries a stroke risk comparable to atrial fibrillation, so accurate diagnosis on an ECG is essential.
In flutter the impulse circles a single organised circuit at about 300 beats per minute, usually giving a regular pulse near 150. In atrial fibrillation the activity is chaotic and the pulse irregular — see /conditions/atrial-fibrillation. Flutter produces a characteristic saw-tooth ECG pattern.
Palpitations, a fast pounding heartbeat, breathlessness on exertion, reduced exercise tolerance, fatigue, chest discomfort and light-headedness. Some people have no symptoms and flutter is found incidentally. See /conditions/heart-palpitations.
A 12-lead ECG is diagnostic when flutter is present. Because it is often intermittent, 24-hour to 7-day Holter monitoring is frequently needed (see /conditions/holter-monitor), alongside an echocardiogram and thyroid, kidney and electrolyte blood tests.
Management combines rate or rhythm control, catheter ablation — which has a high long-term success rate for typical right-sided flutter — and treatment of underlying drivers such as blood pressure, alcohol, thyroid disease and sleep apnoea. Anticoagulation is decided using formal stroke-risk scoring with your cardiologist.
Neither is straightforwardly more serious. Flutter tends to produce faster, more sustained rates that are harder to control with medication, while carrying a comparable stroke risk. Its predictable circuit means ablation is particularly successful.
Yes — the two frequently coexist and can convert into one another, and some people develop AFib after a successful flutter ablation. Ongoing rhythm monitoring and stroke-risk review remain important.
For typical right-sided flutter, catheter ablation has a high long-term success rate and is often described as curative for that circuit, though it does not guarantee freedom from all future arrhythmias.
Many people do, based on formal stroke-risk scoring rather than symptom frequency. This requires individual assessment balancing stroke risk against bleeding risk with your cardiologist.