The positive flutter wave in V1 suggests that the exit site of the circuit is from the posterior LA near the pulmonary veins. Probable left sided atrial flutter-which often is characterized by minimal flutter deflections observed in the frontal axis. The ECG above belongs to an 80 years-old man. Birgul Varan has donated the above ECG to our website.ĮCG 12. It was recorded during Adenosine infusion.Īdenosine-induced transient AV block permitted the clear observation of P waves: atrial flutter. The ECG above is from a child with narrow QRS tachycardia. Mahmut Gokdemir has donated the above ECG to our website.ĮCG 11. The rhythm is atrial flutter with variable degrees of AV block. The ECG above belongs to a 14 years-old boy with restrictive cardiomyopathy who is awaiting cardiac transplantation. Two hours after ingestion of 80 mg of Sotalol, the block level is increased. ![]() The patient complains of fatigue but not palpitation.ĮCG 9b. Some flutter waves are not seen since they coincide with the QRS complexes.ĮCG 8. The regular and rapid flutter waves in C1 confirm In this ECG, it is difficult to see the flutter waves at a first glance. Since the block has increased to 4:1, flutter waves can be clearly seen in chest leads (C1-C6).ĮCG 7. 4:1 block is observed in the same patient on another day. Isoelectric baseline is not seen in lead D2.įlutter waves are not clearly seen in chest leads.ĮCG 6b. Flutter waves are best seen in leads II and aVF. Isoelectric baseline is not observed in leads II, III and aVF due to flutter waves.ĮCG 6a. Atrial flutter in a patient with permanent cardiac pacemaker. Atrial flutter with variable block in a mitral stenosis patient under beta blocker therapy.ĮCG 4. ![]() This is the Holter recording of the patient whose ECGs before and after the electrical cardioversion are depicted above.ĮCG 3. On Holter recordings, the flutter waves ( sawtooth appearance) may not always be easy to recognize. The ECG of the same patient immediately after successful electrical cardioversion with biphasic 200 Joules.ĮCG 2. The rhythm strip in a patient with atrial flutter just before electrical cardioversion.ĮCG 1b. ![]() Indian Pacing Electrophysiol J 2010 10:278-280.Ĭhou's Electrocardiography in Clinical Practice. When its rate is slowed by medication, atrial flutter may mimick sinus rhythm with 1st degree AV block, at first glance (flutter waves may be falsely perceived as P waves). Similarly, in patients with preexisting bundle branch block, development of atrial flutter with a 1 to 1 conduction to the ventricles may resemble ventricular tachycardia at first glance.Ītrial flutter may develope in patients taking propafenone for recurrent episodes of atrial fibrillation (both classical and atypical electrocardiographic and atrial activation patterns have been described) ![]() In patients with preexisting bundle branch block, development of supraventricular tachycardia may resemble ventricular tachycardia at first glance. On the other hand, atrial fibrillation may be seen in patients without organic heart diseases.Ītrial flutter is less common than atrial fibrillation in adults but more common in children. The pharmacological control of ventricular rate is more difficult in atrial flutter than atrial fibrillation.Ītrial flutter usually occurs in subjects with organic heart diseases. The ventricular rate is expected to be low in patients receiving high dose digoxin, amiodarone or beta blocker therapy. Holter recordings may show alternating episodes of atrial flutter and atrial fibrillation in the same patient. When needed, Lewis lead modification may be used to see flutter waves more clearly. Sometimes, level of block may change spontaneously.Įven though the block may vary, atrial flutter is still accepted as a regularly irregular arrhythmia since level of block is not completely irregular. Usually there is a 2:1, 3:1 or 4:1 AV block. Īll flutter waves cannot be conducted to ventricles. The high rate of atrial deflections result in " sawtooth " appearance.įlutter waves are best seen in leads II, III and aVF. Usually, there is no isoelectric baseline between atrial deflections (P waves). This is a regular atrial arrhythmia with an atrial rate of 250-350/minute.
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