Which waveform pattern identifies atrial flutter on telemetry?

Which waveform pattern identifies atrial flutter on telemetry?

• A. Sawtooth flutter waves best seen in II, III, aVF; regular or variable ventricular response; no discrete P waves before QRS.
• B. Irregular rhythm with no P waves; irregular R-R.
• C. Wide complex tachycardia with QRS duration >0.12 s.
• D. Narrow complex tachycardia with hidden P waves.

Answer: (A)

Atrial flutter shows a rapid, organized atrial rhythm that creates a characteristic sawtooth pattern of flutter waves, most clearly visible in the inferior leads (II, III, aVF). The atrial rate is typically around 250–350 beats per minute, while the ventricular rate depends on how many flutter waves are conducted to the ventricles; you may see a regular ventricular rhythm with a fixed conduction ratio (for example, 2:1) or a variable rhythm if the AV conduction changes. The key feature is that there are no discrete P waves before each QRS; instead, the atrial activity appears as those sawtooth flutter waves between QRS complexes. This helps distinguish it from other tachyarrhythmias: an irregular rhythm with no P waves points to atrial fibrillation, a wide complex tachycardia suggests ventricular tachycardia, and a narrow complex tachycardia with hidden P waves corresponds to other SVTs without the classic sawtooth flutter pattern.

Atrial flutter shows a rapid, organized atrial rhythm that creates a characteristic sawtooth pattern of flutter waves, most clearly visible in the inferior leads (II, III, aVF). The atrial rate is typically around 250–350 beats per minute, while the ventricular rate depends on how many flutter waves are conducted to the ventricles; you may see a regular ventricular rhythm with a fixed conduction ratio (for example, 2:1) or a variable rhythm if the AV conduction changes. The key feature is that there are no discrete P waves before each QRS; instead, the atrial activity appears as those sawtooth flutter waves between QRS complexes. This helps distinguish it from other tachyarrhythmias: an irregular rhythm with no P waves points to atrial fibrillation, a wide complex tachycardia suggests ventricular tachycardia, and a narrow complex tachycardia with hidden P waves corresponds to other SVTs without the classic sawtooth flutter pattern.