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 often caused by a re-entry circuit around the tricuspid valve. It 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.

Featured Example

References

Related

  • See also: Atrial Rhythms
  • Fibrillation and flutter:
  • Irregularly irregular rhythms:
  • Regularly Irregular Rhythms:

ECG Library (47)

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In the ECGquest archives, this ECG has been tagged with: - 12-Lead Atrial flutter Dr Smith's ECG Blog CC BY-NC
Right sided heart failure and tachycardia. 29536

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 12-Lead Absent P waves Anterior ST depression Extreme tachycardia Inferior ST elevation Narrow QRS Normal Axis Reciprocal ST depression Regular Tachycardia Atrial flutter Multi-vessel disease Dr Smith's ECG Blog CC BY-NC
Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide. 28056

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: - 12-Lead Anterior ST elevation Inferior ST depression Lateral ST elevation Atrial flutter Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
Tachycardia and ST Elevation. 27544

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: - 12-Lead Anterior ST elevation Lateral ST elevation Pathological Q waves Atrial flutter Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
Tachycardia and ST Elevation – repeat day 2 27635

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 12-Lead Absent P waves Regular Short QRS Tachycardia Atrial flutter Pericardial effusion Dr Smith's ECG Blog CC BY-NC
A Middle-Aged Man with Chest pain, Hypotension and Tachycardia: ED ECG 1 26453

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 12-Lead Flutter P waves Regular Right Axis Deviation Tachycardia Tall QRS Atrial flutter ECG of the Week CC-BY-NC-SA
ECG of the Week – 2nd July 2018 – Interpretation 25608

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: - 12-Lead Flutter P waves Atrial flutter Dr Smith's ECG Blog CC BY-NC
What is the cause of this patient’s inferior ST depressions? 9041
In the ECGquest archives, this ECG has been tagged with: - Vomiting 12-Lead Serial 12-lead Flutter P waves Irregular Narrow QRS Tachycardia Atrial flutter Change in rhythm Dr Smith's ECG Blog CC BY-NC
Inferolateral ST elevation, vomiting, and elevated troponin – repeat on diltiazem drip 17108
In the ECGquest archives, this ECG has been tagged with: - Vomiting 12-Lead Flutter P waves Narrow QRS Regular Tachycardia Atrial flutter Dr Smith's ECG Blog CC BY-NC
Inferolateral ST elevation, vomiting, and elevated troponin 9199
In the ECGquest archives, this ECG has been tagged with: - Vomiting 12-Lead Serial 12-lead Flutter P waves Narrow QRS Regular Tachycardia Atrial flutter Dr Smith's ECG Blog CC BY-NC
Inferolateral ST elevation, vomiting, and elevated troponin – repeat ECG 17102
In the ECGquest archives, this ECG has been tagged with: - Vomiting 12-Lead Serial 12-lead Flutter P waves Narrow QRS Regular Tachycardia Atrial flutter Change in rhythm Dr Smith's ECG Blog CC BY-NC
Inferolateral ST elevation, vomiting, and elevated troponin – repeat ECG 2, with vomit 17105
In the ECGquest archives, this ECG has been tagged with: - Palpitations Rhythm Strip Flutter P waves Atrial flutter Dr Smith's ECG Blog CC BY-NC
What happens when you give adenosine to a patient with this rhythm? – after adenosine 17237