Atrial flutter is an abnormal heart rhythm that 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
- 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. (3.84 mb)
Click for next Rhythm Review: Atrial Fibrillation
Questions Asked On This Page
When the SA node is not firing properly, you can have a very rapid atrial rate which will usually result in more p-waves than normal. There will also be more p-waves than QRS complexes. This usually presents as atrial flutter. Sometimes, the AV node does not conduct every normal p-wave (it is blocked). This is where we see the different blocks like 1st, 2nd, and 3rd, degree block.
Regarding ventricular issues, you can have ventricular arrhythmias that fire from the ventricular tissue rather than traveling through the normal pathways of the AV node. This is called VT. It can be quite deadly, and can quickly diminish oxygenation to the heart which will lead to VF.
To recap, when you see p-waves, you are looking at the electrical activity in the atria. When you see the QRS complexes, you are looking at the electrical activity in the ventricles.