Activity Title

The ECG Diagnosis of Atrial Fibrillation and Atrial Flutter

Activity Overview

This course will improve your ability to accurately diagnose atrial fibrillation and atrial flutter on the ECG. We explain how the underlying pathogenic mechanisms generating these arrhythmias result in predictable findings on the ECG. We discuss the importance of the detection of irregularity of rhythm in the diagnosis of atrial fibrillation. We explain the mechanism of decremental conduction by the AV node and teach you how to identify evidence of decremental conduction on the ECG in cases of atrial flutter. We illustrate the limitations of the computer interpretation (CI) reported on many ECG readouts in the diagnosis of these arrhythmias. We teach you the importance of overall clinical context and a high index of suspicion in diagnosing atrial flutter. We show you examples of conditions capable of mimicking atrial fibrillation on the ECG. In case studies, we show you how an experienced generalist approaches the ECG diagnosis of atrial fibrillation and atrial flutter.


Planner and Author: Dr. John Seery, MB, PhD

  • Consultant Physician at St. Vincent's University Hospital, Dublin, Ireland
  • Lecturer at the School of Medicine and Medical Science, University College Dublin, Ireland
  • Studied medicine at the University of Cambridge, United Kingdom
  • A natural sciences graduate of Trinity College Dublin, Ireland
  • PhD in Cell Biology from University College London, United Kingdom

Planner: Karen Strahan, PhD (Cantab), Head of Editorial

Planner: Tommy O'Sullivan, CME Manager

Estimated Time to Complete

2 hours

Target Audience

  • Physicians (General Internal Medicine, Family Physicians)
  • Nurses
  • Nurse Practitioners
  • Physician Assistants
  • Paramedics

Learning Objectives

Upon successful completion of this activity, you will be able to:

  • Describe the pathogenesis of atrial flutter and atrial fibrillation and how this relates to expected ECG findings
  • Recognize the conditions frequently misdiagnosed as atrial fibrillation and the pitfalls commonly encountered in the diagnosis of atrial flutter
  • Explain the limitations of the computer interpretation in the diagnosis of atrial flutter and atrial fibrillation
  • Explain the mechanism of decremental conduction by the AV node
  • Appropriately identify and differentiate atrial fibrillation and atrial flutter on the ECG
  • Consider and use the clinical context in the ECG diagnosis of atrial flutter

Activity Content

  • Introduction
  • The Frontal Schematic
  • Atrial Fibrillation: The Mechanism of Chaos
  • Atrial Fibrillation: ECG Findings
  • What is Atrial Flutter?
  • Atrial Flutter: Mechanism
  • The AV Node: Decremental Conduction
  • Atrial Flutter and Decremental Conduction
  • Atrial Flutter: ECG Finding
  • Atrial Flutter: An Illustrative Case
  • Atrial fibrillation and Flutter: Clinical Approach
  • Quiz
  • Quiz Explanation

Release Date


Expiration Date


Instructions for Participation

Participants must complete the online activity during the valid period as noted above.

Follow these steps:

  1. View videos in sequence
  2. Complete quiz
  3. View and complete post quiz video to support learning outcomes and objectives
  4. Complete the activity evaluation form to provide feedback for continuing education purposes and for the development of future activities
  5. Download the Certificate of Completion

Relevant Financial Disclosures

Planners and faculty for this activity have no relevant financial relationships with commercial interests to disclose.


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Nishida K et al. Atrial fibrillation pathophysiology: implications for management. Circulation 2011;124:2264-74.

Seery JP and Ryan J. Why does atrial flutter fool us so often? Top ten tips to minimise uncertainty.

Seery JP and Ryan J. How to diagnose atrial fibrillation-top 5 tips.

Shiyovich A et al. Accuracy of diagnosing atrial flutter and atrial fibrillation from a surface electrocardiogram by hospital physicians: analysis of data from internal medicine departments. Am J Med Sci 2010;340(4):271-5.

Smulyan H. The Computerised ECG: Friend and Foe. Am J Med 2019 132:153-60.

Waldo AL. Mechanism of atrial flutter and atrial fibrillation: distinct entities or two sides of a coin? Cardiovascular research 2002;54(2):217-29.


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