Atrial Flutter || EMS Cardiology

Atrial Flutter (aka A flutter) is an abnormal cardiac 🫀 rhythm where the atria (top chambers of the heart) of the heart contracts faster than normal. The ventricles (bottom chambers of the heart) are unable to match the speed at which the atria are contracting. This arrhythmia does reduce the hearts ability to pump blood.

Let's talk about some the characteristics of atrial flutter on an EKG!

Rate: The atria and ventricles actually have different rates as the atria are typically contracting more than the ventricles. The atrial rate could range from 200-400 bpm, where the ventricles might have a rate between 60-160. 

Regularity: A flutter is a typically regular rhythm. It is common to have a regular conduction rate associated with it. For example, the conduction rate in the photo is 4:1 and this would indicate that there are 4 p waves for every QRS complex. 

P waves: The appearance of the p waves makes atrial flutter typically easy to identify. These p waves can be referred to as flutter waves and can have a shark fin appearance. 

PR Interval: Typically normal 

QRS Complex: Typically normal

As an EMS provider in the 911 prehospital setting, you may only see atrial flutter a handful of times in your career and there is no guarantee an intervention will even be needed. If, however, there is a symptomatic patient with atrial flutter w/ RVR (rapid ventricular response), there are treatments that can be attempted. 

Some of those treatments can include calcium channel blockers (like diltiazem), beta blockers 💊 and even cardioversion ⚡️ (typically vagal maneuvers are ineffective). Cardioversion is not ideal in the field as the risk of dislodging a blood clot is present, but a possibility if needed. Treatment would all depend on scope, protocol, patient presentation, vitals, what medications the service carries, transport time, etc. 

#atrialflutter #emscardiology #paramediccardiology #lightssirensactionems #lightssirensaction