Medscape is available in 5 Language Editions – Choose your Edition here.


Pediatric Atrial Flutter Differential Diagnoses

  • Author: M Silvana Horenstein, MD; Chief Editor: Steven R Neish, MD, SM  more...
Updated: Feb 11, 2014

Diagnostic Considerations

Atrial flutter must be differentiated from atrial fibrillation and chaotic atrial tachycardia. When atrial flutter is conducted to the ventricle in a 1:1 fashion, the electrocardiogram may resemble ventricular tachycardia. In patients with a 2:1 conduction ratio, the ECG findings often suggest a mild sinus tachycardia with first-degree AV block.

Go to Atrial Flutter and Emergent Management of Atrial Flutter for complete information on these topics.

Differential Diagnoses

Contributor Information and Disclosures

M Silvana Horenstein, MD Assistant Professor, Department of Pediatrics, University of Texas Medical School at Houston; Medical Doctor Consultant, Legacy Department, Best Doctors, Inc

M Silvana Horenstein, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Medical Association

Disclosure: Nothing to disclose.


Robert Murray Hamilton, MD, MSc, FRCPC Electrophysiologist, Senior Associate Scientist, Physiology and Experimental Medicine, Labatt Family Heart Centre; Professor, Department of Pediatrics, University of Toronto Faculty of Medicine

Robert Murray Hamilton, MD, MSc, FRCPC is a member of the following medical societies: American Heart Association, Canadian Medical Association, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Canadian Medical Protective Association, Heart Rhythm Society, Canadian Cardiovascular Society, Cardiac Electrophysiology Society, Pediatric and Congenital Electrophysiology Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Steven R Neish, MD, SM Director of Pediatric Cardiology Fellowship Program, Associate Professor, Department of Pediatrics, Baylor College of Medicine

Steven R Neish, MD, SM is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association

Disclosure: Nothing to disclose.


Alvin J Chin, MD Professor of Pediatrics, University of Pennsylvania School of Medicine; Attending Physician, Cardiology Division, Children's Hospital of Philadelphia

Alvin J Chin, MD, is a member of the following medical societies: American Association for the Advancement of Science, American Heart Association, and Society for Developmental Biology

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

  1. Biviano A, Garan H, Hickey K, Whang W, Dizon J, Rosenbaum M. Atrial flutter catheter ablation in adult patients with repaired tetralogy of Fallot: mechanisms and outcomes of percutaneous catheter ablation in a consecutive series. J Interv Card Electrophysiol. 2010 Aug. 28(2):125-35. [Medline].

  2. Boriani G, Gallina M, Merlini L, et al. Clinical relevance of atrial fibrillation/flutter, stroke, pacemaker implant, and heart failure in Emery-Dreifuss muscular dystrophy: a long-term longitudinal study. Stroke. 2003 Apr. 34(4):901-8. [Medline].

  3. Nazarian S, Wagner KR, Caffo BS, Tomaselli GF. Clinical predictors of conduction disease progression in type I myotonic muscular dystrophy. Pacing Clin Electrophysiol. 2011 Feb. 34(2):171-6. [Medline]. [Full Text].

  4. Frost L, Hune LJ, Vestergaard P. Overweight, obesity and risk factors for atrial fibrillation or flutter--secondary publication.The cohort study Diet, Cancer and Health. Ugeskr Laeger. 2005 Sep 12. 167(37):3507-9. [Medline].

  5. Frost L, Vestergaard P. Alcohol consumption and the risk of atrial fibrillation or flutter--secondary publication. A cohort study. Ugeskr Laeger. 2005 Aug 29. 167(35):3308-10. [Medline].

  6. Frost L, Vestergaard P, Mosekilde L. Hyperthyroidism and risk of atrial fibrillation or flutter--secondary publication. A population-based study. Ugeskr Laeger. 2005 Aug 29. 167(35):3305-7. [Medline].

  7. Movahed MR, Hashemzadeh M, Jamal MM. Diabetes mellitus is a strong, independent risk for atrial fibrillation and flutter in addition to other cardiovascular disease. Int J Cardiol. 2005 Dec 7. 105(3):315-8. [Medline].

  8. Earing MG, Cetta F, Driscoll DJ. Long-term results of the Fontan operation for double-inlet left ventricle. Am J Cardiol. 2005 Jul 15. 96(2):291-8. [Medline].

  9. Balaji S, Daga A, Bradley DJ, Etheridge SP, Law IH, Batra AS, et al. An international multicenter study comparing arrhythmia prevalence between the intracardiac lateral tunnel and the extracardiac conduit type of Fontan operations. J Thorac Cardiovasc Surg. 2013 Oct 27. [Medline].

  10. Krapp M, Kohl T, Simpson JM. Review of diagnosis, treatment, and outcome of fetal atrial flutter compared with supraventricular tachycardia. Heart. 2003 Aug. 89(8):913-7. [Medline].

  11. Southall DP, Johnson AM, Shinebourne EA, Johnston PG, Vulliamy DG. Frequency and outcome of disorders of cardiac rhythm and conduction in a population of newborn infants. Pediatrics. 1981 Jul. 68(1):58-66. [Medline].

  12. Silversides CK, Harris L, Haberer K. Recurrence rates of arrhythmias during pregnancy in women with previous tachyarrhythmia and impact on fetal and neonatal outcomes. Am J Cardiol. 2006 Apr 15. 97(8):1206-12. [Medline].

  13. Liberman L, Pass RH, Starc TJ. Optimal surface electrocardiogram lead for identification of the mechanism of supraventricular tachycardia in children. Pediatr Emerg Care. 2008 Jan. 24(1):28-30. [Medline].

  14. Liberman L, Hordof AJ, Altmann K, Pass RH. Low energy biphasic waveform cardioversion of atrial arrhythmias in pediatric patients and young adults. Pacing Clin Electrophysiol. 2006 Dec. 29(12):1383-6. [Medline].

  15. Stulak JM, Dearani JA, Puga FJ. Right-sided Maze procedure for atrial tachyarrhythmias in congenital heart disease. Ann Thorac Surg. 2006 May. 81(5):1780-4; discussion 1784-5. [Medline].

  16. Naccarelli GV, Wolbrette DL, Levin V, et al. Safety and efficacy of dronedarone in the treatment of atrial fibrillation/flutter. Clin Med Insights Cardiol. 2011. 5:103-19. [Medline]. [Full Text].

  17. Oudijk MA, Ruskamp JM, Ververs FF, et al. Treatment of fetal tachycardia with sotalol: transplacental pharmacokinetics and pharmacodynamics. J Am Coll Cardiol. 2003 Aug 20. 42(4):765-70. [Medline].

  18. Rebelo M, Macedo AJ, Nogueira G, Trigo C, Kaku S. Sotalol in the treatment of fetal tachyarrhythmia. Rev Port Cardiol. 2006 May. 25(5):477-81. [Medline].

Rhythm strip depicting lead II of a patient with atrial flutter with an atrial rate of 300 beats per minute (bpm). Atrioventricular conduction rate is variable at 2:1 and 3:1. Therefore, the ventricular rate ranges from 100-150 bpm.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.