**4. Clinical presentation**

Atrial flutter can be paroxysmal or persistent. When atrial flutter is associated with an increased ventricular response, it can result in palpitations, shortness of breath, chest pain, fatigue or pre-syncope. If a patient presents with atrial flutter and a rapid ventricular rate, stroke, tachycardia-induced cardiomyopathy and rarely myocardial infarction are complica‐ tions that can be encountered. Syncope in the setting of atrial flutter is rare if there is no significant cardiac history [11]. When presenting because of a more prolonged episode, increased symptoms of heart failure may be evident. Occasionally, atrial flutter is an incidental finding on ECG with patients who are completely asymptomatic.
