|Click to enlarge|
- Mean ventricular rate bpm
- Atrial rate ~300 bpm
- Atrial flutter with variable high grade block (4:1 --> 10:1)
- QRS - Normal (80ms)
- ST Depression leads V3-4 likely secondary to superimposed flutter waves
- 'Saw tooth' baseline appearance
- Flutter waves - negative in inferior leads and positive in V1
- Atrial flutter
- Typical counter-clockwise
- High grade variable block
What happened ?
Following discussion with the patient's cardiologist they were DC cardioverted with reversion to sinus rhythm and improvement in heart rate to 60-70 bpm.
More information on flutter classification / types:
- Medi C, Kalman JM. Prediction of the atrial ﬂutter circuit location from the surface electrocardiogram. Europace (2008) 10, 786–796. FULL TEXT
- Pedrinazzi C, Durin O, Mascioli G, Curnis A, Raddino R, Inama G, Dei Cas L. Atrial flutter: from ECG to electroanatomical 3D mapping. Heart Int. 2006;2(3-4):161. FULL TEXT
Both papers provide in-depth reviews of atrial flutter classifications, both new & old, and how the ECG and advanced EP techniques can help differentiate them
References / Further Reading
Life in the Fast Lane
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.