Atrial Flutter

Created by team@ekgdx.com on Feb. 12, 2023

Let’s talk about atrial flutter.

Atrial flutter is an arrhythmia resulting from reentry in a macroreentrant circuit, most commonly in the right atrium. It is characterized by regular atrial activity with “sawtooth” appearance.

Criteria

  • Atrial rate usually 300/min (usual range 250-350 bpm).
  • “F” waves with “sawtooth” appearance, best seen in inferior leads and V1.
  • Absence of baseline.
  • PR interval unmeasurable.

 

Same rhythm strip with graphical explanation. 

 

Note the negative fluter waves (F waves) with AV conduction ratio of 2:1 and ventricular rate of ~150 bpm.

 

Atrial Flutter

Another example with clear F waves.

 

Atrial flutter with 2:1 conduction.

 

NOTE: Odd ratios (1:1, 3:1, 5:1) are really uncommon.

NOTE: Atrial flutter is probably the most overlooked arrhythmia. 

NOTE: The most common AV ratio is 2:1, resulting in a ventricular rate of ~150 bpm.

NOTE: Atrial flutter can be typical or atypical depending on whether the cavotricuspid isthmus (CTI) participates or not in the reentrant circuit.

NOTE: Atrial flutter with 1:1 conduction and wide QRS is rare but often mistaken for ventricular tachycardia.

NOTE: Atrial flutter may presents with variable AV conduction, particularly after receiving cardiac medications.

Possible causes: The same as for atrial fibrillation

Do you want to practice with complex EKGs?

If you are a cardiology fellow who needs to practice for the ABIM cardiology board or you are someone who wants to practice with complex 12-lead EKGs, our Volume II is what you need.

Do you want to improve your EKG skills?

With our unique, revolutionary and innovative educational platform, you will learn EKG easier than ever. Download the App here and get started. I hope you enjoy our interactive way of learning EKG. 

References

Popular articles

Related articles

It may interest you

Read more

 

Thanks for joining us. 

Dr. Roig

Atrial Flutter