Atrial Flutter


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  • Rate

    • Atrial flutter (f) wave rate: 240-320 bpm
    • Ventricular rate
      • At 1:1 conduction (uncommon): 240-320 bpm
      • At 2:1 conduction (common): 120-160 bpm
  • Atrial flutter is more organized than AF, with a saw-tooth pattern of regular atrial activation called flutter (f) waves on the ECG, particularly visible in leads II, III, and aVF

  • Untreated, the atrial rate typically ranges from 240-320 bpm, with f waves inverted in ECG leads II, III, and aVF and upright in lead V1
    • The wave of activation in the right atrium (RA) may be reversed, resulting in f waves that are upright in leads II, III, and aVF and inverted in lead V1
  • Two-to-one AV block is common, producing a ventricular rate of 120-160 bpm
  • Atrial flutter can degenerate into AF, AF can initiate atrial flutter, or the ECG pattern can alternate between atrial flutter and AF, reflecting changing atrial activation


  • Stable:
  • Unstable: synchronized cardioversion 50-100 J


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