Atrial Flutter (A Flutter)(AF) 

Atrial Flutter 4-1

A type of atrial tachycardia characterized by contraction rates between 230/min and 380/min. Two kinds, typical and atypical, have been identified and are distinguished from each other by their rates and electrocardiographic (ECG) patterns. During typical atrial flutter the atrial rate is between 290/min and 310/min and produces "fence post" or "sawtooth" ECG waves. During atypical atrial flutter the atrial rate is higher, and the ECG waves lack the sawtooth appearance, and are often sinusoidal. For both types, ventricular contractions usually follow atrial contractions in a 1:2, 1:3, 1:4, or variable ratio. It may be cured with electrophysiologic radiofrequency ablation. 


Rate Atrial rate 250-450 BPM Ventricular rate variable

Rhythm Atrial Regular 
Ventricular regular or irregular 

P-Waves No identifiable P waves, Saw toothed “Flutter” waves are present 

PR Interval Not measurable.

QRS Duration 0.11 sec (2 1⁄2 small boxes) or less, but may be widened if the flutter waves are buried in the QRS complex


Stable Symptomatic with Rapid Ventricular Rate

Administer Diltiazem .25mg/kg SIVP


(Best to consult cardiologist prior to treatment)

Stable Symptomatic with Rapid Ventricular Rate 

Monitor Diagnostic 12 lead

Oxygen 15 LPM NR Mask

IV 18g

Administer Meds

Diltiazem .25mg/kg SIVP

Serious Signs and Symptoms with Rapid Ventricular Rate.

Consider Synchronized Cardioversion.

Noticeable by: 

The Atrial waveforms that are produced resemble the teeth of a saw or a picket fence

© Matt Dillard 2012