What Is the Difference between Atrial Fibrillation and Flutter?

Atrial flutter and atrial fibrillation are arrhythmias that occur in the atrium and have a higher impulse frequency than atrial tachycardia. When the frequency of atrial ectopic pacing points is 250-350 beats / min, the atrial contraction is fast and coordinated as atrial flutter. If the frequency is 350 beats per minute and irregular, it is atrial fibrillation. Both can have both paroxysmal and chronic persistent types. This disease is a common arrhythmia in cardiology clinics, which mostly occurs in patients with rheumatic heart disease, coronary heart disease, hyperthyroidism, cardiomyopathy, hypertension, etc. It can also occur in patients without organic heart disease (idiopathic atrial fibrillation).

Basic Information

Visiting department: Cardiology, Cardiac Surgery
Common locations: heart
Common causes: Rheumatic heart disease, mitral valve stenosis, coronary heart disease, hyperthyroid heart disease, cardiomyopathy (including Keshan disease), myocarditis, hypertension heart disease, etc.

Contagious: no

Atrial flutter and atrial fibrillation

The causes of atrial flutter and fibrillation are basically the same. The most common are rheumatic heart disease, mitral valve stenosis, coronary heart disease, hyperthyroid heart disease, cardiomyopathy (including Keshan disease), myocarditis, and hypertensive heart disease. . Others include constrictive pericarditis and sick sinus node syndrome. A few cases of paroxysmal atrial fibrillation have no obvious cause, and they are called idiopathic atrial fibrillation. In recent years, some people think that it may be related to factors such as viral infection or degeneration of conductive tissues or instability of autonomic nerves.

Atrial flutter and clinical manifestations of atrial fibrillation

1. Medical history and symptoms

Clinical symptoms depend on the frequency of atrial flutter, the frequency of atrial fibrillation, the rate of ventricular rate at the time of the attack, and the presence of underlying heart disease. Mild can be asymptomatic or mild palpitation, shortness of breath, severe can have obvious cardiac insufficiency, angina pectoris. The medical history should pay attention to asking about the frequency and time of atrial flutter, atrial fibrillation, the application of the drug at each attack, and the drug currently being used, and whether there is a history of thromboembolism.

2. Physical examination found

In addition to the clinical manifestations of underlying heart disease, the auscultatory arrhythmia may be regular or irregular (depending on the ratio of atrial to ventricular conduction). During atrial fibrillation, the auscultation of the heart is absolutely irregular, and the heart sounds vary. Less than the heart rate. Blood pressure needs to be measured to rule out high blood pressure. Eye protrusion and fine tremor in both hands should be observed to rule out hyperthyroidism.

Atrial flutter and atrial fibrillation

ECG examination

The main signs of atrial fibrillation are absolutely irregular heart rhythms and varying heart sounds. The patient's pulse rate is significantly less than the heart rate, which is called short pulse. The arrhythmia may be regular or irregular, depending on the ratio of atrial and ventricular conduction, such as 3: 1 or 6: 1. Ventricular rules.

(1) Atrial flutter P wave: Atrial flutter wave (F wave) that disappears, is replaced by absolute rules of shape, interval, and amplitude, and is sawtooth-like. The frequency is 250 to 350 times per minute. Atrioventricular conduction: The most common atrioventricular conduction ratio is 2: 1, which produces fast and regular ventricular rhythms around 150 times per minute, followed by a 4: 1 atrioventricular conduction ratio, forming a ventricle 70 to 80 times per minute rate. Sometimes the atrioventricular conduction ratio is not constant, causing irregular ventricular rhythms. QRS complex morphology: It is mostly the same as sinus rhythm, and it can also have ventricular differential conduction.

(2) Atrial fibrillation P wave: Atrial fibrillation wave (f wave) disappearing, replaced by morphology, interval and amplitude are absolutely irregular, frequency is 350 to 600 times per minute; QRS wave group interval: absolutely irregular, its shape and Amplitudes can often vary.

2. Auxiliary inspection

In addition to the clear diagnosis of the ECG, the rate of ventricular rate during atrial flutter and atrial fibrillation can also be understood, which is of guiding significance for treatment. The P wave of the atrial flutter disappears and is replaced by a sawtooth atrial flutter wave (F wave). The ventricular conduction ratio can be 2: 1, 3: 1 or 4: 1, QRS is supraventricular, P wave disappears during atrial fibrillation, and it is replaced by atrial fibrillation wave (f wave) with absolutely irregular shape, spacing and amplitude. , QRS spacing is absolutely irregular. A 24-hour ambulatory electrocardiogram is helpful for the diagnosis of paroxysmal atrial flutter and atrial fibrillation, and can understand the highest and lowest ventricular rates during an episode. In addition to detecting changes in the structure of the heart, echocardiography can also understand the presence of mural thrombus in the atrium.

Atrial flutter and atrial fibrillation diagnosis

ECG can make a clear diagnosis.

Differential diagnosis of atrial flutter and atrial fibrillation

When atrial flutter, atrial fibrillation with ventricular block, or impulse pass along the sideways of preexcitation syndrome, it should be distinguished from ventricular tachycardia and ventricular fibrillation.

Atrial flutter and atrial fibrillation complications

After atrial flutter or atrial fibrillation occurs, it is easy to cause thrombosis in the room. Partial thrombolysis may cause systemic arterial embolism. Cerebral embolism is the most common clinical and often leads to death or disability.

Atrial flutter and atrial fibrillation treatment

In addition to the treatment of causes and causes, the focus is to minimize the symptoms of patients, reduce and prevent recurrence, and prevent the occurrence of thrombosis and embolism. Relieving symptoms is effective in controlling ventricular rate during seizures, and it is preferred to slowly push quietly after dilute cedilan. It is forbidden when hypokalemia and drug poisoning occur. You can also use amiodarone or Xinluping to dilute slowly after diluting. Chronic atrial flutter or atrial fibrillation can be taken orally with digoxin or amiodarone to control the ventricular rate at 70 to 90 beats / min. There are no effective drugs and methods to prevent the recurrence of atrial flutter and atrial fibrillation. Amiodarone and equal heart rate can be tried. Enteric-coated aspirin, or warfarin can be used to prevent thrombosis and embolism, but pay attention to the side effects of the drug.