• Ventricular Flutter
• ECG and Ventricular Flutter
• Flutter, Fibrillation, and Asystole

Ventricular Flutter

• Ventricular flutter is a ventricular tachycardia
• It occurs in a structurally or electrically damaged heart
• The most common cause is myocardial infarction
• Mechanism is macro re-entry in the ventricles
• Re-entry does not pass through the His-Purkinje system
• If it does pass through the system, it is a ramienková re-entry VT
• Frequency is usually 300/min. (250-350/min.)
• At this frequency, the heart does not function as a pump
• It is a life-threatening condition, requiring urgent treatment - defibrillation
• Ventricular activity (re-entry) creates a sawtooth pattern on the ECG (from QRS complexes)
• Atrial flutter creates a sawtooth pattern (in the atria from P waves)
• Within a few seconds, it transitions to ventricular fibrillation
• Macro re-entry begins to form numerous micro re-entry foci

Ventricular Flutter

• In structurally altered ventricles, there is macro re-entry
• Frequency is 300/min.
• The heart does not function as a pump (ineffective diastole)
• QRS complexes resemble sawtooth waves
• ECG looks the same even if you turn it "upside down"
• Very quickly (within a few seconds) transitions to ventricular fibrillation
• Requires urgent treatment - defibrillation

Flutter, Fibrillation, and Asystole

• Flutter and Ventricular Fibrillation are life-threatening high-frequency ventricular arrhythmias
• The heart does not function as a pump due to extreme ventricular tachycardia
• Often one arrhythmia transitions into another (Flutter most commonly transitions into fibrillation)
• As energy stores are depleted, the amplitude of QRS complexes gradually decreases
• Flutter transitions to fibrillation in several seconds, and after about 2 minutes, asystole occurs

Ventricular Fibrillation and Asystole

• Ventricular fibrillation without defibrillation transitions to asystole in about 2 minutes

Ventricular Flutter

• Frequency approximately 300/min.
• QRS complexes resemble sawtooth patterns
• The EKG looks the same even when turned "upside down"
• Ventricular flutter transitions to ventricular fibrillation within a few seconds

Ventricular Fibrillation

• Frequency approximately 300/min.
• QRS complexes are low amplitude and irregular
• This is ventricular fibrillation
• Ventricular flutter has higher amplitude QRS complexes
• There is no clear EKG boundary between Flutter and Fibrillation
• Flutter transitions to fibrillation within a few seconds