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Rate:
- Mean ventricular rate 132 bpm
- Atrial flutter
- Variable block 2:1, 3:1
- Right axis deviation
- QRS - Normal (100ms)
- Minor ST depression inferior leads may be secondary to superimposed flutter waves
- Flutter waves - rate ~300 bpm
- Negative flutter waves in inferior leads with positive waves in V1
Interpretation:
- Atrial Flutter
- Variable Block
- Typical Counter-clockwise flutter
The patient's significant underlying cardiac and pulmonary disease precluded DC cardioversion. He was treated with digoxin and following resolution of his hypoxaemia he reverted to sinus rhythm.
More information on flutter classification / types:
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
Textbook
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.
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