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
ECG Ventricular flutter

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

PVT-with-verapamil 2
  • 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.

Related Topics

LITFL Further Reading

Advanced Reading




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

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