Perioperative medicine & anaesthesia · UKMLA & AKT
Atrial flutter
A free high-yield preview for the UKMLA Applied Knowledge Test, covering how to recognise this condition. The full SA Note notes add investigations, management and complications, with practice questions on this topic.
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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