Atrial Flutter

Atrial Flutter

This abnormal heart rhythm technically falls under the category of supra-ventricular tachycardias. Atrial flutter is typically not a stable rhythm and will frequently degenerate into atrial fibrillation.


Atrial Flutter will usually present with atrial rates between 240-350 beats per minute. These rapid atrial rates are caused by electrical activity that moves in a self-perpetuating loop within the atria.

The impact and symptoms of atrial flutter depend upon the ventricular rate of the patient (i.e. cardiac output). Usually, with atrial flutter, not all of the atrial impulses will be conducted to the ventricles, and the more atrial impulses that are conducted, the greater the negative effect.


Symptoms of atrial flutter are similar to those of atrial fibrillation and may include the following:

  • palpitations, chest pain or discomfort
  • shortness of air
  • lightheadedness or dizziness
  • nausea
  • nervousness and feelings of impending doom
  • symptoms of heart failure such as activity intolerance and swelling of the legs occur with prolonged fast flutter)


As with its symptoms, atrial flutter shares the same complications as atrial fibrillation. These complications are usually due to ineffective atrial contractions and rapid ventricular rates. Ineffective atrial contractions can lead to thrombus formation in the atria and rapid ventricular rates can cause decompensation and heart failure.

Prevent complications from atrial flutter with early cardioversion.


For the purposes of ACLS, atrial flutter is treated the same as atrial fibrillation. When atrial flutter produces hemodynamic instability and serious signs and symptoms, it is treated using ACLS protocol.

For the patient with unstable tachycardia due to this tachyarrhythmia (atrial flutter), immediate cardioversion is recommended. Drugs are not used to manage unstable tachycardia.


Atrial flutter is considerably more sensitive to electrical direct-current cardioversion than atrial fibrillation, and usually requires a lower energy shock. 20-50J is commonly enough to revert to sinus rhythm.

AHA recommends an initial shock dose 0f 50-100 J for cardioverting unstable atrial flutter.

Below is a short video which will help you quickly identify atrial flutter on a monitor.
Please allow several seconds for the video to load.


  1. says


    what the heck is the F wave you elude to in the ACLS algorithm video. I am thinking that it is a mis-type and should be P. i am sure that i am not the only one that noticed this. thanks for correcting.

  2. chichi says

    Hi …I have read about ECG in my accident and emergency course but my problem is that I seem not to understand how to interpretation it ….The stable tachycardia n unstable tachycardias….i really want to understand

    • says

      Unstable tachycardia exists if a tachycardia is causing serious signs and symptoms in a patient. These serious signs and symptoms are related to poor blood perfusion.

      Stable tachycardia exists if the patient has a tachycardia rhythm but continues to have good blood perfusion. I hope this answers your question.

      Kind regards,

  3. Elaine12 says

    I had an aha moment with the regular rate (a-flutter) and the irregular rate (a-fib) now on the video I can see the difference. Thank you.

  4. Kathy gee says

    “20-50J is commonly enough to revert to sinus rhythm.” but
    “AHA recommends an initial shock dose 0f 50-100 J for cardioverting unstable atrial flutter.”
    What dose is used for a flutter ?
    When should you use the lower amount?
    Thank you

    • says

      The shock dose that American Heart Association recommends is 50 to 100 Joules.

      There are times when expert cardiologist will use lower shock doses in certain situations. These lower shock deuces are typically reserved for experts who are very familiar with cardiac physiology.

      Kind regards,

  5. rioboy10 says

    2 quick questions….
    In reference to A-Fib/A-Flutter (Stable), is the treatment to provide supplementary care (02, IV, Monitor, Pulse Ox, etc.) only and no Vagal Maneuvers and/or Adenosine 6mg/12mg IV?
    Also, in ACLS, is the treatment for A-Fib/A-Flutter only in unstable pts?, which we would then go to synchronized cardioversion?
    I just want to make sure that I fully understand the treatment modalities for stable A-Fib/A-Flutter because in the manual (AHA pg. 165), it states that Adenosine does not convert A-Fib and A-Flutter.
    Thanks in advance for the help……this is a great site.

    • rioboy10 says

      In simpler terms…..

      In cases where the A-Fib and A-Flutter is “stable”, do we monitor the pt. only? and only treat A-Fib and A-Flutter if the pt. is deemed to be unstable?

      Thanks again,

      • says

        For stable atrial fibrillation and atrial flutter (new onset) monitoring the patient and the other interventions that you mentioned would be important, but you would also be looking for causes, consulting cardiology, and possibly using medications, like calcium channel blockers, to slow a rapid rate down. These other interventions for stable a-fib and a-flutter are important.

        For the patient with any type of new onset atrial fibrillation (stable or unstable) it is important to rule out thrombus before a cardioversion is performed.

        Kind regards,

  6. David says

    the page says that drugs are not used to manage unstable tachycardia but wouldn’t adenosine be used if cardioversion failed to convert the patient?

    • David says

      I was just hopping around the site, which is great by the way, but I may have misread the first time. It’s just the irregular unstable tachy rhythms that wouldn’t be treated with adenosine at all right?

      • says

        Not exactly correct, but close. You would treat any unstable tachycardia with adenosine. You would go straight to cardioversion in all cases of unstable tachycardia where there is no underlying cause like sepsis. I’m talking about rates that will typically exceed 150 and most likely greater than 170.

        Kind regards,

    • says

      I have never seen adenosine used after cardioversion when treating unstable tachycardia.
      Amiodarone would probably be a better choice especially when dealing with wide complex tachycardia.
      Kind regards,

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