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

Online

Textbooks


LITFL Further Reading

ECG LIBRARY 700

ECG LIBRARY

Electrocardiogram

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) 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

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.