Ventricular Flutter

Clinical Significance

  • Extreme form of 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

 Pearls

  • The ECG looks identical when viewed upside down!

ECG Examples

Example 1

Typical appearance of ventricular flutter:

  • Monomorphic sine wave at >200bpm.
  • ECG looks identical when turned upside down.

 

Example 2

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.

 

Related Topics

Further Reading

Author Credits

References

  • 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.
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