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.
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.
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.
- Jenkins RD, Gerred SJ. ECGs by Example. Second Edition. Elsevier Churchill Livingstone 2005.
- Surawicz B, Knilans TK. Chou’s Electrocardiography in Clinical Practice. 6th Edition. Saunders Elsevier 2008.