Clinical Significance of Ventricular flutter
Extreme form of ventricular tachycardia (VT) with loss of organised electrical activity
- Associated with rapid and profound hemodynamic compromise
- Usually short lived due to progression to ventricular fibrillation
- As with ventricular fibrillation rapid initiation of advanced life support is required
How to Recognise Ventricular Flutter
- Continuous Sine Wave
- No identifiable P waves, QRS complexes, or T waves
- Rate usually > 200 beats / min
The ECG looks identical when viewed upside down!
Typical appearance of ventricular flutter:
- Monomorphic sine wave at >200bpm.
- ECG looks identical when turned upside down.
12-lead ECG example of ventricular flutter:
- Extremely rapid monomorphic sine wave at around 300 bpm.
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.
LITFL Further Reading
- ECG Library Basics – Waves, Intervals, Segments and Clinical Interpretation
- ECG A to Z by diagnosis – ECG interpretation in clinical context
- ECG Exigency and Cardiovascular Curveball – ECG Clinical Cases
- 100 ECG Quiz – Self-assessment tool for examination practice
- ECG Reference SITES and BOOKS – the best of the rest
- Brady WJ, Truwit JD. Critical Decisions in Emergency and Acute Care Electrocardiography
- Surawicz B, Knilans T. Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric
- Wagner GS. Marriott’s Practical Electrocardiography 12e
- Chan TC. ECG in Emergency Medicine and Acute Care
- Rawshani A. Clinical ECG Interpretation
- Mattu A. ECG’s for the Emergency Physician
- Hampton JR. The ECG In Practice, 6e