A Flutter irregular, it is A Fib?

  1. Hi.

    I work in a cardiac hospital and we were taught that if a A flutter strip has R-R intervals that are irregular then it is AFib. The head EKG instructor said A flutter is always regular.

    What do you guys think? and why?

    Thank you!!:spin:
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  2. 7 Comments

  3. by   jmgrn65
    Atrial flutter is not always regular, the best way to tell them is Flutter waves look like saw teeth, an Fib looks like a squiggly worm.
  4. by   LadyT618
    Quote from jmgrn65
    Atrial flutter is not always regular, the best way to tell them is Flutter waves look like saw teeth, an Fib looks like a squiggly worm.
    This is what I was always told.
  5. by   EricJRN
    One important distinction: the atrial rate in atrial flutter is regular, while the ventricular rate may be regular or irregular.
  6. by   agent66
    Your ventricular rate will only be regular in A-flutter if your flutter rate is constant , ie 4:1 , 3:1 etc., that is 4 flutter waves to every one ventricular complex.(or 3 or whatever the ratio is) If the f-waves are conducting at different ratios then the qrs cannot be regular. So yes, aflutter can be irregular if the f-waves are conducting at varying ratios to the qrs.
  7. by   Spatialized
    It can be regular, if the conduction rate is stable. For example, if it is a 3:1 flutter. But in cases where the block is variable, your ventricular rate will be variable as well. It also helps to look at other leads to see if you see f-waves, or just the fib line.

    One important distinction: the atrial rate in atrial flutter is regular, while the ventricular rate may be regular or irregular.
    Right, it's always trucking along at like 300, just depends on how many of those beats goes thru. 'Tis why when you have RVR, the rate is in the 150's or so. Took me a second though to remember why...

    Cheers,
    Tom
  8. by   eamon66
    Hi,

    Afib is as a result of multiple foci within the atria whilst Aflutter is unifocal. Afib usually has an irregular ventricular rate (with the exception of when there is also a complete heart block). Maybe your instructor meant that the flutter rate was always constant but the ventricular rate can be both regular (1:1, 2:1, 3:1 etc) and irregular (called Aflutter with variable block).
  9. by   eprnlittlerock
    hey, the best way to tell what the rythym is, is to take the pt to the ep lab. by putting catheters in the heart, you will be better able to tell. it depends on where the focus is coming from. the av node slows the conduction. most a-fib come from around the pulmonary veins. you have to put a catheter into the coronary sinus. most a-fib is left sided(from left atrium), flutter is mostly right sided(right atrium).

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