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Various ECG patterns produced by atrial flutter. A: A trial flutter showing the typical sawtoothed pattern is present. The atrial rate is unusually slow at about
220/min. The flutter waves deform the ST segments, mimicking ST elevation (arrows). Careful attention to the variation in QRST morphology should
provide a clue to the correct diagnosis. The ventricular rate shows group beating characteristic of type I (Wenckebach) second-degree block of the flutter
impulses. Type I atrioventricular (AV) block of flutter impulses that occurs within the AV node has no clinical significance since the AV nodal block often
occurs in response to rapid atrial rates. B: F lutter waves superimposed upon QRS complexes deform them (arrows), mimicking an intermittent
intraventricular conduction delay. Careful measurement of the atrial rate provides evidence that the wave deforming the downstroke of the QRS complexes
Source: Heart Disease, Current Medical Diagnosis & Treatment 2017
is a flutter wave. Note the unusually slow flutter rate of about 190/min. C: F lutter waves having the same amplitude as the QRS complexes (arrows) mimic
Citation: Papadakis
MA, McPhee SJ,
RabowofMW.
Current
& Treatment
2016 Available
at:waves
http://mhmedical.com/
a period of ventricular
asystole. Simultaneous
recording
other
leads Medical
will moreDiagnosis
clearly define
the QRS2017;
complexes.
D: Flutter
superimposed upon
Accessed:
May
05,
2017
the downstrokes of the QRS complexes (arrows) mimic ST-segment depression. E: Flutter waves occurring at the ends of the QRS complexes (arrows)
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mimic a Qr configuration
intraventricular
conduction
delay.
Since the ventricular rate is regular at 150/min, the diagnosis of atrial flutter with 2:1 AV
conduction should always be strongly considered. (Reproduced, with permission, from Goldschlager N, Goldman MJ. Principles of Clinical