Carotid sinus massage is useful in bringing out a diagnosis of atrial flutter because the increase in the grade of AV block makes the flutter waves more evident. Since atrial flutter is due to a macro re-entry, it is the arrhythmia which is most sensitive to cardioversion at low energies. Hence a narrow QRS tachycardia with a rate of 150/min, which appears to be SVT is likely to be atrial flutter with 2:1 conduction.Ĭlose scrutiny of the baseline for saw-tooth like flutter waves, especially in the inferior leads is needed to exclude atrial flutter. A typical situation of atrial flutter is with 2:1 conduction, atrial rate of 300/min and ventricular rate of 150/min. If there is 1:1 conduction, the ventricular rates will be very high. If the waves are positive in inferior leads, it is clockwise loop and if negative, the re-entry loop is counter-clockwise.Ītrial flutter is usually associated with a fixed ratio AV block. The direction of the less sharp component of the flutter wave is taken as the direction of the wave. Isthmus dependent flutter can be typical and reverse typical depending on whether the re-entry is counter-clockwise or clockwise. Non isthmus dependent flutters are the scar related flutters and caval mediated flutters. In the left atrium there is mitral isthmus. In the right atrium it is the cavotricuspid isthmus. Atrial flutter can be classified into isthmus dependent and non-isthmus dependent.
Atrial flutter is an organized atrial tachyarrhythmia due to macro re-entry typically with saw tooth shaped flutter waves in the ECG.
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