SVT vs Atrial Flutter

[Misty1]

What methods can be used to differentiate between the two? I've been looking all over for a take home test I have and the strip (wish I could post) I put SVT but wondering if it may be Atrial Flutter with fast ventricular rate.

I'm thinking of putting possible Atrial Flutter with fast ventricular rate.

Thanks if anyone can help.

[TakeBack]

AVNRT is the most common variant of SVT. AF and flutter are technically SVTs but the common parlance of SVT refers to AVNRT, atrioventricular tachycardia (accessory pathway), and atrial tachycardia.

AVNRT will not always show a PA wave- it may be before, buried, or after the QRS.

SVT is more likely to be regular.

For an equivocal ECG, adenosine is the best way to differentiate the two- it will block AVN conduction, and as the R-R widens you will see flutter waves or not.

If a pt is hypotensive and in a narrow complex tachyarrhythmia, don't use adenosine; sync cardiovert.

Another option is available if you have atrial temporary pacing wires, which is an atrial ECG (attach the pacer wires to alligator clips on the ECG machine, or touch them to the chest leads). It will show large amplitude narrow complexes where the atrial activity is. (I know this is not your test, but good to have in the back of your head).....

[ghillbert, MSN, NP]

Man, it's a long time since I did an atrial ECG - I *loved* doing them when unsure of the rhythm. Nowadays most of my patients don't have routine atrial wires postop though.

[TakeBack]

I do them occasionally and the unit RNs look at me like I'm crazy. They do not teach this skill at my place.....

[JustMe]

ARGH!!!!!!!! Correct answer : Do an EKG. That was in my answer seems like sometimes we make things harder then they have to be.

That was my initial thought. And this is why I don't like these types of test questions. SVT vs AF are rhythms that CANNOT be answered with only 1 or 2 leads especially if the rate is very high. Yes a slower paper speed can help I guess. But a better answer than ANY of them is: GO LOOK AT THE PATIENT! Doesn't matter what the rhythm is if your patient is circling the drain. When I help my students with rhythm strips I give them clear rhythms to interpret, nothing wishy-washy. If seasoned nurses like me have occasional difficulty with interpretation, how can we expect students to do it for a test?

Just my