Atrial Flutter

View Rhythm Strip
Transcutaneous PacingStep-by-step setup, capture & troubleshooting
TC Pacing — Quick Steps
Full guide →
  1. Apply pads anterior–posterior; attach ECG leads from the pacer/monitor.
  2. Pre-medicate for discomfort: midazolam ± fentanyl if BP allows.
  3. Set mode Demand (synchronous), rate 60–80/min.
  4. Increase output (mA) by 5–10 until electrical capture (wide QRS after each spike).
  5. Confirm mechanical capture: palpate femoral/right brachial pulse (not carotid).
  6. Set final output ~10 mA above threshold; reassess BP, perfusion, mentation.
  7. Bridge to transvenous pacing or treat underlying cause.
ANTERIORANTPOSTERIORPOSTSandwich the heart between pads
A–P pad placement

Rhythm strip

Source ↗
Sawtooth flutter wavesRegular ventricular responseOften 2:1 conduction (~150)
Schematic placeholder — tap labels to highlight key features.

Tap a label on the strip to highlight the matching feature below.

  • Sawtooth flutter waves (II/III/aVF)
  • Regular ventricular response (usually)
  • Atrial ~300; ventricular ~150 (2:1) or ~100 (3:1)
Recognition
  • Sawtooth flutter waves best seen in II, III, aVF
  • Atrial rate ~ 300; ventricular rate often 150 (2:1) or 100 (3:1)
  • Regular ventricular response (unless variable block)
Management
Unstable
  • — often converts at low energy (50–100 J)
Stable
  • : diltiazem or metoprolol (same as AFib)
  • : ibutilide, amiodarone, or elective cardioversion
  • : cavotricuspid isthmus ablation (typical flutter)

Educational reference only. Always follow current ACLS guidelines and institutional protocols.