Atrial Flutter

  • More organized, saw-tooth type pattern seen on standard 12-lead EKG.
    • Negative flutter waves in inferior leads
    • Positive flutter waves in V1
    • Typical Flutter = counterclockwise reentry around tricuspid annulus.
  • Rate is ~250/min; noted as 2:1 or 4:1 for its atrial rate and the ratio of electrical conduction down the AV node.
  • Atrial Flutter is often seen in patients diagnosed with concomitant Atrial Fibrillation (Fib-Flutter).
  • Similar to AFib – think CHA2DS2-VASc for stroke prevention.
  • Benefit of Rate vs. rhythm control is the same.
  • CAN require larger doses of AV nodal blockers (CCBs or BBs).
  • Catheter ablation for typical flutter is generally preferred (high success rate).

ACP MKSAP 17:  Cardiovascular Medicine, pp. 58
Image obtained via Google web search.

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