Ventricular flutter I49.0

Ventricular flutter is a life-threatening heart rhythm with a frequency of between 200 - 300 / min (Haas 2011).

Ventricular flutter is one of the tachycardic ventricular arrhythmias (Braun 2022).

Ventricular flutter can be caused by electrical instability. This can be triggered by:

• Changes in the heart structure, e.g. dilatation, hypertrophy, fibrosis, scarring in post-myocardial infarction
• Changes in cardiac function such as coronary insufficiency or ischemia in acute myocardial infarction (Braun 2022).

In most cases, ventricular flutter occurs directly in the ventricular myocardium through reentry mechanisms or through increased ectopic autonomy of the ventricle (Hick 2025).

When ventricular flutter occurs, the shortened diastolic filling time (Hick 2025) leads to a dramatic drop in both cardiac output and arterial blood pressure (Braun 2022).

If ventricular flutter occurs, unconsciousness occurs within a few minutes (Braun 2022).

ECG

The diagnosis is usually made by recording an ECG. This shows a constant morphology with deformed ventricular complexes and a very wide amplitude. There are uniform, sinusoidal or sawtooth-like changes (Striebel 2015).

The transition from ventricular tachycardia to ventricular flutter is fluid, as is the transition from ventricular flutter to ventricular fibrillation (Braun 2022). In ventricular tachycardia, it is still possible to distinguish between depolarization and repolarization, whereas in ventricular flutter, the distinction is no longer possible (Kiening 2022).

- Ventricular fibrillation

This is a tachycardic but disordered tachycardia in contrast to ventricular flutter, which shows a regular tachycardia (Braun 2022).

• Ventricular fibrillation

With ventricular flutter, there is always a risk of ventricular tachycardia and ventricular fibrillation. The latter can lead to functional cardiac arrest (Haas 2011).

• Sudden cardiac death (Braun 2022)

If left untreated, ventricular flutter usually leads to sudden cardiac death (Braun 2022). Treatment is the same as for circulatory arrest, i.e. electrocardioversion and resuscitation measures. Otherwise, the underlying disease should be treated (Herold 2019).

The prognosis depends on the underlying disease and appropriate prophylaxis (Herold 2019).

In the case of prehospital cardiac arrest triggered by ventricular fibrillation, the survival rate is only 5 - 8 %. Early defibrillation is crucial (Trappe 2009).

Patients with significant left ventricular dysfunction and after the occurrence of ventricular flutter more than 48 hours after an acute myocardial infarction are at high risk of recurrent ventricular flutter/ventricular fibrillation. For this reason, these patients should be prescribed a permanent beta blocker and an IC defibrillator (implantable cardioverter defibrillator) should be implanted (Braun 2022).