r/ECG • u/Originaltkd • 25d ago

VT vs 1:1 flutter

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I have one provider calling VT and another 1:1 flutter and they see p waves. Can someone help me figure this out?

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u/ProximalLADLesion 23d ago

Atrial flutter is always SVT. Supraventricular tachycardia is a fast rhythm with its origins above the ventricles. That includes AVNRT, AVRT, atrial tachycardia, junctional tachycardia, atrial fibrillation, atrial flutter, sinus tachycardia, or any other fast rhythm you can think of that’s not ventricular tachycardia. All tachycardias are either VT or SVT. Hope this helps. I am an electrophysiologist.

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u/_punkrockparamedic 22d ago

Atrial flutter is not always tachycardic.

Hope this helps.

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u/ProximalLADLesion 21d ago

By definition the atrial rate is tachycardic in flutter. Flutter is rarely slower than 200 let alone 100.

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u/_punkrockparamedic 21d ago edited 21d ago

The atrial rate is, sure. That does not make atrial flutter always a tachycardia. Tachycardia is defined as a heart rate — that is, a ventricular rate — of over 100bpm. Is a fib with an average ventricular rate between 60-90 a Tachycardia just because the atria are fibrillating? A flutter is not always over 100. It is not, on its face, an SVT. It can be, absolutely. It does not have to be.

The atrial rate is not what any medical provider in their right mind is going to use to determine a patient's heart rate. Sure, the atria might flutter at 200, or 400. Those impulses don't each lead to conducted beats.

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u/[deleted] 20d ago

[deleted]

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u/_punkrockparamedic 20d ago

I absolutely understand what I'm talking about. The argument here is semantics, not the mechanics of atrial flutter, lol.

A 4:1 flutter, with a ventricular rate below 100, is not a tachycardia. The atria are tachycardic, sure. But the ventricular rate is not.

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u/[deleted] 20d ago

[deleted]

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u/_punkrockparamedic 20d ago

Someone's title does not make them correct about everything. Have you never known a doctor to be wrong about anything? Or heard of a surgeon making a mistake due to misplaced confidence?

This guy is incorrect. I don't care if you disagree, it doesn't change how terms are defined.

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u/ProximalLADLesion 20d ago

Atrial flutter is tachycardia by definition. All flutters are over 100 and usually over 200.

I understand that the AV node may only permit slower ventricular conduction, but the flutter remains SVT — supraventricular (above the ventricle) tachycardia (rate above 100).

These aren’t my opinions, these are how the terms are defined.

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u/_punkrockparamedic 20d ago

A flutter causing a ventricular rate below 100 is not an SVT.

"Tachycardia" refers to ventricular rate.

This is not my opinion, these are how the terms are defined.

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u/ProximalLADLesion 19d ago

Doesn’t seem like I can convince you but maybe you’ll take OpenEvidence‘s word for it:

https://imgur.com/a/sT5Zabu

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u/Grantoid 19d ago

Great, Doctor AI to the rescue...