What is the role of vagal maneuvers in the diagnosis of atrial flutter (AFL)?

Updated: Nov 18, 2019
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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Answer

Vagal maneuvers can be helpful in determining the underlying atrial rhythm if flutter waves are not seen well. Adenosine, administered in an intravenous (IV) push followed with an IV bolus with flush, can also be helpful in making the diagnosis of atrial flutter by transiently blocking the atrioventricular node (see the image below). Approximately 15% of atrial tachycardias will also terminate with adenosine.

Rhythm strips demonstrating typical atrial flutter Rhythm strips demonstrating typical atrial flutter unmasked by adenosine (Adenocard).

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