ECG Quest > Rhythms > Atrial Rhythms > Atrial flutter

Atrial flutter

Atrial flutter is a rhythm that features flutter waves at a rate around 300 bpm (240-360) that make the baseline resemble a sawtooth pattern. The ventricular rate is often half this rate (~150 bpm), which is known as 2:1 conduction. Medications may slow the conduction to less than 2:1. Rarely there may be 1:1 conduction through the AV node, which can produce dangerously fast ventricular rates.

Atrial flutter is frequently confused with SVT (e.g. AVNRT) or sinus tachycardia. Adenosine can help to diagnose atrial flutter by making the sawtooth flutter waves more obvious at slower rates, but adenosine will not treat it. Lewis leads can also help to unmask atrial activity.

See also: Atrial Rhythms

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References

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In the ECGquest archives, this ECG has been tagged with: - Atrial flutter 12-Lead Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
Right sided heart failure and tachycardia.

This ECG is from a middle aged man who presented with tachycardia, dyspnoea and bilateral leg oedema.

This ECG shows atrial flutter precipitating worsening right heart failure. The flutter waves in V1 were unusually negative (mimicking sinus tachycardia) due to marked right atrial enlargement.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea Extreme tachycardia Normal Axis Regular Tachycardia Absent P waves Anterior ST depression Inferior ST elevation Narrow QRS Reciprocal ST depression Atrial flutter Multi-vessel disease 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.

This ECG is from a man in his 60s who presented with intermittent shortness of breath and chest pressure over the past few days. This was his initial ECG.

This ECG shows a regular narrow complex tachycardia around 200 bpm, without P waves, with marked ST elevation in inferior leads and ST depression in anterior leads and aVL. The cause was thought to be atrial flutter from newly started flecainide. He also underwent angiography and had stents inserted to the left circumflex and right coronary arteries.

In the ECGquest archives, this ECG has been tagged with: - Anterior ST elevation Inferior ST depression Lateral ST elevation Atrial flutter Acute Anterior MI 12-Lead Dr Smith's ECG Blog Dr Ken Grauer K. Wang CC BY-NC
Tachycardia and ST Elevation.

This ECG is from a middle aged man presented with tachycardia, leg oedema and a raised JVP. This was his initial ECG.

In the ECGquest archives, this ECG has been tagged with: - Anterior ST elevation Lateral ST elevation Pathological Q waves Atrial flutter Acute Anterior MI 12-Lead Dr Smith's ECG Blog Dr Ken Grauer K. Wang CC BY-NC
Tachycardia and ST Elevation – repeat day 2

This ECG is from a middle aged man presented with tachycardia, leg oedema and a raised JVP. This was his repeat ECG the next day after cardioversion and catheterisation.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Hypotension Regular Tachycardia Absent P waves Short QRS Atrial flutter Pericardial effusion 12-Lead Dr Smith's ECG Blog CC BY-NC
A Middle-Aged Man with Chest pain, Hypotension and Tachycardia: ED ECG 1

This ECG is from a middle-aged man who presented with chest pain, tachycardia 130 bpm and BP 50/30. He was alert but cool and clammy. His background was unclear, but he mentioned chronic dyspnoea, 'cancer' and 'chest'. Fluids were started. This was his second ECG, on arrival at hospital.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Regular Right Axis Deviation Tachycardia Flutter P waves Tall QRS Atrial flutter 12-Lead ECG of the Week Dr John Larkin CC-BY-NC-SA
ECG of the Week – 2nd July 2018 – Interpretation

This ECG is from a woman in her 50s who presented with chest pain on a background of mitral stenosis secondary to rheumatic fever.

In the ECGquest archives, this ECG has been tagged with: - Flutter P waves Atrial flutter 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog CC BY-NC
What is the cause of this patient’s inferior ST depressions?
In the ECGquest archives, this ECG has been tagged with: - Vomiting Regular Tachycardia Flutter P waves Narrow QRS Atrial flutter Change in rhythm 12-Lead Serial 12-lead Dr Pendell Meyers Dr Smith's ECG Blog CC BY-NC
Inferolateral ST elevation, vomiting, and elevated troponin – repeat ECG 2, with vomit