💓

Understanding Atrial Fibrillation and Flutter

Apr 15, 2025

EKG Rhythms: Atrial Fibrillation and Atrial Flutter

Introduction

  • Presenter: Sarah from Registered Nurse RN
  • Topic: Differentiating between atrial fibrillation, atrial flutter, and normal sinus rhythm
  • Objective: Understand differences and learn to analyze EKG rhythms

Five Steps to Analyze EKG Rhythms

  1. Check for P Waves
    • Indicates atrial contraction
    • Count P waves in a 6-second strip (count 30 small boxes and multiply by 10)
  2. Are P Waves Regular?
    • Use calipers or paper to measure P wave regularity
  3. Are R Waves Regular?
    • Part of QRS complex (spike)
    • Measure regularity same as P waves
  4. R Wave Count
    • Count R waves in a 6-second strip
  5. PR Interval and QRS Complex Width
    • PR interval: Look for heart block, should be 0.12-0.20 seconds
    • QRS complex: Narrow in tachycardias, wide in v-tach, should be <0.12 seconds

Normal Sinus Rhythm

  • P Waves: Present before each QRS
  • Atrial Rate: Count P waves (e.g., 7 P waves = 70 bpm)
  • Regularity: Both P and R waves are regular
  • PR Interval: Normal (0.12-0.20 seconds)
  • QRS Complex: Narrow

Atrial Fibrillation (A-fib)

  • P Waves: Absent, replaced by fibrillatory (F) waves
  • R Waves: Irregular
  • Rate: Fluctuates (e.g., 80 bpm but can vary)
  • PR Interval: Cannot be determined
  • QRS Complex: Narrow
  • Risk: Thrombi formation leading to stroke or pulmonary embolism

Atrial Flutter (A-flutter)

  • P Waves: Absent, replaced by sawtooth F waves
  • R Waves: Typically regular
  • Rate: Stable (e.g., 70 bpm)
  • PR Interval: Cannot be determined
  • QRS Complex: Narrow
  • Characteristic: Sawtooth F waves distinguish from A-fib

Differences Between A-fib and A-flutter

  • A-fib: No P waves, irregular R waves
  • A-flutter: Sawtooth F waves, regular R waves

Practical Analysis: Quiz Questions

  1. Rhythm Identification
    • No P waves, irregular R waves: Likely A-fib
  2. Rhythm Analysis
    • Sawtooth F waves, regular R waves: Likely A-flutter
  3. Normal Sinus Rhythm
    • Presence of P waves, regular R waves: Normal sinus rhythm
  4. A-fib Confirmation
    • No P waves, irregular R waves detected

Conclusion

  • Differentiating A-fib and A-flutter involves recognizing wave patterns and regularity
  • Practice by taking quizzes and reviewing tutorials on registerednursern.com

Additional Resources

  • Recommended: Visit Registered Nurse RN for quizzes and tutorials
  • Subscribe to their YouTube channel for more educational content

Full transcript