Perioperative medicine & anaesthesia · UKMLA & AKT

Atrial flutter

A free high-yield preview for the UKMLA Applied Knowledge Test. Below are the key points to recognise atrial flutter — the full SA Note notes add investigations, management, complications and 10 practice questions.

Key high-yield points

  • Macro-re-entrant atrial arrhythmia - circuit rotates around the cavotricuspid isthmus at ~300 bpm
  • AV node cannot conduct 300 impulses/min - conducts every 2nd, 3rd, or 4th impulse (2:1, 3:1, 4:1 block)
  • 2:1 block → ventricular rate of exactly 150 bpm (300 ÷ 2)
  • Variable block - conduction ratio changes beat to beat → irregular ventricular rhythm (can mimic AF clinically)

A ventricular rate of exactly 150 bpm on ECG should always prompt a careful search for flutter waves - one flutter wave is often hidden within the QRS or T wave in 2:1 block.

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Related UKMLA topics

Atrial fibrillationSupraventricular tachycardia (SVT)Ventricular tachycardiaVentricular fibrillationBradyarrhythmias and heart blockWolff-Parkinson-White syndrome,