AFib & Atrial Flutter Essentials
Key recognition features and rate implications of atrial fibrillation and atrial flutter.
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Questions Covered in This Set
10 cards to master
What two findings define atrial fibrillation on EKG?
No discernible P waves (chaotic fibrillatory baseline) AND irregularly irregular R-R intervals.
What is the atrial rate in atrial fibrillation?
400–600 impulses per minute — chaotic, non-organized quivering.
What is the atrial rate in atrial flutter?
About 300 bpm (typically 250–350), from an organized re-entry loop around the tricuspid annulus.
Best leads to see typical flutter waves?
Inferior leads II, III, aVF (negative sawtooth) plus an upright deflection in V1.
A regular narrow-complex tachycardia at ~150 bpm is what until proven otherwise?
Atrial flutter with 2:1 conduction.
How do you unmask hidden flutter waves at 2:1 conduction?
Vagal maneuvers or IV adenosine to transiently block the AV node; also compare T-wave shape in II to a prior EKG.
How should you count the rate in AFib?
Use the 6-second rule: count QRS complexes in 6 seconds (30 big boxes) × 10, and report as an average.
What does AFib that becomes perfectly regular suggest?
Complete heart block with a junctional or ventricular escape rhythm — classically digoxin toxicity.
How do you distinguish flutter with variable conduction from AFib?
Flutter still shows organized, identical, repeating atrial waves at a fixed ~300/min, and R-R intervals tend to be multiples of the flutter cycle length.
What is the QRS width expected in AFib?
Narrow (<120 ms), unless there is a pre-existing bundle branch block or rate-related aberrancy.
