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Atrial Flutter, Emergency Medicine

Liesl A. Curtis Reviewed 06/2017



  • Atrial dysrhythmia

  • 200,000 new cases each year

  • A macroreentrant circuit in the right atrium is thought to be the underlying mechanism.

  • Most sensitive rhythm to cardioversion

  • Seldom occur...


Signs and Symptoms

  • Palpitations

  • Syncope/presyncope

  • Chest pain

  • Fatigue

  • Dyspnea

  • Poor exercise capacity

  • Tachycardia—HR >150 bpm:

  • Hypotension

  • Heart failure

  • Infants do not tolerate atrial flutter well.

  • T...



  • Oxygen, monitor, IV access

  • Unstable patients should be cardioverted in the field:

    • Immediate synchronized cardioversion

    • Start with 100 J

Initial Stabilization/Therapy

  • Oxygen, monitor, ...



Admission Criteria

  • New-onset atrial flutter requiring antidysrhythmics, rate control

  • Symptomatic (i.e., chest pain that warrants a rule out or cardioversion)

  • CHF

Discharge Criteria

  • New...

Pearls and Pitfalls

  • Be aware of WPW:

    • Do not use adenosine, β-blockers, calcium channel blockers, and digoxin (Class III can be harmful).

      • Can cause increased ventricular response, which can deteriorate t...

Additional Reading

  • Clausen  H, Theophilos  T, Jackno  K, et al. Paediatric arrhythmias in the emergency department. Emerg Med J.  2012;29(9):732–737.

  • Fuster  V, Ryden  LE, Cannom  DS, et al. ACC/A...



427.32 Atrial flutter 


  • I48.3 Typical atrial flutter

  • I48.4 Atypical atrial flutter

  • I48.92 Unspecified atrial flutter


  • 5370000 Atrial flutter (disorder)

  • 427665004 paroxysmal atrial flutte...

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