Sections View Full Chapter Figures Tables Videos Annotate 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||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||Download Slide (.ppt) Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.