Atrial flutter electrocardiogram

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2] Farima Kahe M.D. [3]

Overview

Characteristic electrocardiographic findings in a patient with atrial flutter include; an atrial rate from 250-350 beats per minute, a "sawtooth" appearance to the tracings due to rapid regular undulations (F waves), and a variable ventricular rate depending on AV conduction.

Electrocardiogram

Findings on an ECG suggestive of atrial flutter include:

• There are rapid regular undulations (F waves) that cause a sawtooth appearance.
  • Best seen in leads II, III, aVF and V1.
  • Usually inverted in the inferior leads.
  • No isoelectric baselines between the F waves.

• Atrial rate is 250 to 350 Beats Per Minute (BPM).
  • Can be faster in infants and children.
  • Massive dilation of the atria can lead to a rate < 200 BPM.
  • Quinidine can reduce the atrial rate.

• There is a variable ventricular rate depending on the AV conduction.
  • The most common response is 2:1.
  • 3:1 is uncommon.
  • 4:1 suggests the existence of an AV conduction defect
  • May be associated with complete AV block in which case the RR intervals are regular and the F waves have no constant relationship to the QRS. The ventricular response is usually slow.
  • 1:1 conduction may be precipitated by excitement, exercise, induction of anesthesia or any increase in sympathetic tone.

• It may occur in WPW where the impulses are conducted antegrade through the bypass tract. All these are an emergency.
  • During treatment with quinidine the atrial rate may slow sufficiently to permit 1:1 conduction.
  • Vagal maneuvers increase the degree of AV block.

• QRS complex either normal or aberrant depending on preexisting IVCD or aberrant ventricular conduction.

EKG Examples

Shown below is an EKG with an alternating 2:1 and 3:1 atrial flutter.

Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/File:Aflutr_ecg.jpg

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Shown below is an EKG depicting atrial flutter.

Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/Main_Page

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Shown below is an EKG of a 2:1 atrial flutter.

Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/File:ECG_Aflutt.jpg

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Shown below is an EKG of a 2:1 atrial flutter.

Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/Main_Page

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For more EKG examples of atrial flutter click here.