Atrial Flutter vs Supraventricular Tachycardia
Atrial Flutter and Supraventricular Tachycardia are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Atrial Flutter vs Supraventricular Tachycardia at a glance
- Atrial Flutter: Macro-reentrant atrial tachycardia with sawtooth flutter waves; treated like AFib for stroke risk.
- Supraventricular Tachycardia: Regular narrow-complex tachycardia from reentry involving AV node ± accessory pathway — vagal maneuvers, adenosine, ablation.
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Side-by-side comparison
| Feature | Atrial Flutter | Supraventricular Tachycardia |
|---|---|---|
| At a glance | Macro-reentrant atrial tachycardia with sawtooth flutter waves; treated like AFib for stroke risk. | Regular narrow-complex tachycardia from reentry involving AV node ± accessory pathway — vagal maneuvers, adenosine, ablation. |
| Classic presentation | ECG: 'sawtooth' flutter waves (negative deflections in II, III, aVF and positive in V1) in typical counterclockwise flutter.; Often more symptomatic than AFib due to faster, regular ventricular rates; Palpitations, dyspnea, exercise intolerance; Lightheadedness, chest discomfort; May present as new HF or with embolic stroke; Regular… | Sudden-onset palpitations with abrupt termination; Lightheadedness, dyspnea, anxiety; Chest pressure, near-syncope or syncope; Polyuria after episode (atrial natriuretic peptide release); Pre-existing WPW: may present with palpitations or rarely sudden death from pre-excited atrial fibrillation degenerating to VF; Regular rapid pulse… |
| Workup / key labs | TSH, CBC, BMP, magnesium; Coagulation studies; Troponin if ischemia in differential | Typical AVNRT: rate 150-250, narrow QRS, retrograde P waves not visible or just after QRS as pseudo-R' in V1 / pseudo-S in inferior leads. Orthodromic AVRT: retrograde P visible after QRS in ST segment. Manifest WPW on resting ECG: PR <120 ms + delta wave + wide QRS + secondary ST-T changes.; Electrolytes, magnesium, TSH; CBC if anemia… |
| Imaging | 12-lead ECG — diagnostic when flutter waves visible; 2:1 conduction can hide them (rate 150 should prompt vagal maneuvers or adenosine to unmask); TTE for LA size, LV function, valve disease; TEE prior to cardioversion if duration unknown/>48 h and not adequately anticoagulated | 12-lead ECG during tachycardia and in sinus rhythm; Echocardiogram to assess for structural disease, especially before ablation; Holter or event monitor for diagnosis if episodes are infrequent; Electrophysiology study — diagnostic and therapeutic (ablation) |
| First-line treatment | Acute rate control: same as AFib — IV beta-blocker or non-DHP CCB; Anticoagulation: same CHA2DS2-VASc-based decision as AFib (flutter carries equivalent stroke risk); Cardioversion (synchronized DCCV) — flutter typically cardioverts at lower energy (50-100 J biphasic) than AFib (120-200 J); Definitive: catheter ablation of cavotricuspid… | Stable narrow-complex SVT: vagal maneuvers first — Valsalva (modified REVERT maneuver — supine with leg lift improves success), carotid sinus massage (avoid bilateral or in patients with carotid bruits or recent TIA); Adenosine 6 mg rapid IV push followed by saline flush; if no conversion in 1-2 min, give 12 mg, then repeat 12 mg — warn… |
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