Ventricular Flutter

Clinical Significance of Ventricular flutter

Extreme form of ventricular tachycardia (VT) with loss of organised electrical activity

How to Recognise Ventricular Flutter
  • Continuous Sine Wave
  • No identifiable P waves, QRS complexes, or T waves
  • Rate usually > 200 beats / min

Clinical Pearl

The ECG looks identical when viewed upside down!

ECG Examples
Example 1

Typical appearance of ventricular flutter:

  • Monomorphic sine wave at >200bpm.
  • ECG looks identical when turned upside down.

Example 2
ECG ventricular flutter 4 4

12-lead ECG example of ventricular flutter:

  • Extremely rapid monomorphic sine wave at around 300 bpm.

Example 3

Ventricular flutter following a bolus of intravenous verapamil

  • A supraventricular tachycardia converts to ventricular flutter after administration of verapamil. The rhythm subsequently degenerates into ventricular fibrillation.
  • The rapid deterioration with verapamil suggests that the patient may have underlying Wolff-Parkinson White syndrome.
  • In WPW, administration of verapamil or diltiazem during a supraventricular tachycardia may produce a paradoxical increase in ventricular rate by increasing conduction through the accessory pathway. With rapid atrial rhythms such as AF or flutter, the sudden onset of 1:1 AV conduction may produce ventricular rates of >300 beats per minute (i.e. ventricular flutter), which rapidly deteriorates to VF.

Advanced Reading



LITFL Further Reading


Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Adult/Paediatric Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner

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