ATRIAL FLUTTER is Same as Atrial Fibrillation, but common with COPD.


ATRIAL FLUTTER is Same as Atrial Fibrillation but the ectopic atrial impulse formation occurs at the rate of 250-350 per minute. Since AV node cannot transmit more than 210-220 impulses there is a physiological AV block (2: 1). Inciden is far less common than fibrillation.

Atrial flutter results from a Single re-entrant circuit Surrounding a structural or functional conduction barrier in the atrial musculature.


  1. Palpitation.
  2. Breathlessness.
  3. Pain chest.


Flutter should be suspected when pulse is regular at a rate of 120-170 per minute and is not influenced by change of posture, exercise and emotional upsets, i.e., it becomes a fixed pulse. Sometimes flutter waves may be seen in the jugular veins. Pulse rate may vary from time to time depending the degree of AV block. When the ventricular rate is 75 per minute exercise may double the rate. Carotid massage may Cause change in the AV block and thereby slowing of the ventricular rate. Pulse deficit is absent


ECG shows rapid regular F (flutter) waves giving rise to a saw tooth appearance which is well visualized in lead V1 and sometimes in oesophageal leads.

In typical atrial flutter, flutter waves are positive in Vi but negative in II, III and aVF. Flutter and fibrillation may co-exit together which is called Flutter fibrillation or impure flutter.


Paroxysmal and recent onset atrial flutter

Electrical cardioversion with less than 50J is helpful and is the treatment of choice. Verapamil may also slow the ventricular rate transiently but a combination of Digitalis and Quinidine may revert the flutter to sinus rhythm. Digitalisation should not be done when DC shock is planned.

Digitalis may be used as a second choice drug. Intravenous Digitalis should be used.

Right atrial pacing or transvenous pacing may also be done.

Chronic and persistent atrial flutter

Digitalis is the drug of choice. The dose of Digitalis is more than is used conventionally. Propranolol or Verapamil may be used when Digitalis fails. Quinidine should not be used because of the danger of 1: 1 conduction; but may be used in conjunction with Digitalis. In case of refractory atrial flutter radio frequency ablation within the atrium to interrupt the circuit may be done.


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