Background Atrial Flutter (AFL) and Atrial Fibrillation (AF) are common arrhythmias associated with heart failure, leading to significant hemodynamic instability. While rhythm control strategies are well established for AF, their impact on AFL in heart failure patients remains understudied. Methods We analyzed data from the National Inpatient Sample (NIS) database (2018-2020) to compare outcomes between patients with heart failure and AFL undergoing procedural rhythm control (PRC) via Direct Current Cardioversion (DCCV) or Catheter Ablation (CA) versus medical management (MM) alone. The primary outcome was Major Adverse Cardiovascular Event (MACE). Secondary outcomes included length of hospital stay and total hospital charges. Logistic regression and propensity score matching were used for analysis. Results Among 59,845 patients, those undergoing PRC had a significantly lower rate of MACE (10.6% vs. 12.4%, p < 0.05) and all-cause mortality (0.9% vs. 1.5%, p < 0.05) compared to the MM group. PRC was associated with longer hospital stays (4 vs. 3 days, p < 0.05) and higher costs ($56,078 vs. $28,175, p < 0.05). No significant difference in MACE and all-cause mortality was observed between DCCV and CA groups. Conclusion Early procedural rhythm control in patients with AFL and heart failure significantly reduces MACE and all-cause mortality compared to medical management alone. PRC however requires higher costs and longer hospital stays. Further studies are needed to confirm these findings and evaluate long-term benefits.