Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content +++ ECG Findings ++ Tachycardia with a wide monomorphic QRS complex. Ventricular rate may be very rapid (300 bpm). Sine wave appearance with regular large oscillations. +++ Pearls ++ Imagine an atrial flutter sawtooth with much larger amplitude. When you see a very rapid wide-complex tachycardia (> 240 bpm), consider ventricular flutter or WPW with atrial fibrillation or flutter. WPW with atrial flutter may be indistinguishable from ventricular flutter. Ventricular flutter is treated as VT and usually leads to ventricular fibrillation if not promptly corrected with antiarrhythmic medications or electrical cardioversion. Patients with such a rapid rate are almost always unstable. Emergent cardioversion is indicated. If the patient appears to be stable enough for chemical cardioversion, choose a medication that is safe to use with WPW, such as procainamide or amiodarone. ++ FIGURE 23.34A Ventricular Flutter. (ECG contributor: James V. Ritchie, MD.) Graphic Jump LocationView Full Size|Favorite Figure|Download Slide (.ppt) ++ FIGURE 23.34B Very rapid, regular, wide-complex tachycardia with sine wave appearance. The rate in this example is 330 bpm. Differential diagnosis includes WPW with atrial flutter. Graphic Jump LocationView Full Size|Favorite Figure|Download Slide (.ppt) GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessMedicine 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessMedicine Full Site: One-Year Individual Subscription $995 USD Buy Now View All Subscription Options