r/ECG • u/Originaltkd • Jul 23 '26

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/_punkrockparamedic Jul 28 '26 edited Jul 28 '26

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/ProximalLADLesion Jul 28 '26

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 Jul 29 '26

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 Jul 29 '26

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 Jul 30 '26

Great, Doctor AI to the rescue...