Atrial flutter is a rhythm that features flutter waves at a rate around 300 bpm (240-360) that make the baseline resemble a sawtooth pattern. The ventricular rate is often half this rate (~150 bpm), which is known as 2:1 conduction. Medications may slow the conduction to less than 2:1. Rarely there may be 1:1 conduction through the AV node, which can produce dangerously fast ventricular rates.
Atrial flutter is frequently confused with SVT (e.g. AVNRT) or sinus tachycardia. Adenosine can help to diagnose atrial flutter by making the sawtooth flutter waves more obvious at slower rates, but adenosine will not treat it. Lewis leads can also help to unmask atrial activity.See also: Atrial Rhythms
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This ECG is from a man in his 60s who presented with intermittent shortness of breath and chest pressure over the past few days. This was his initial ECG.
This ECG shows a regular narrow complex tachycardia around 200 bpm, without P waves, with marked ST elevation in inferior leads and ST depression in anterior leads and aVL. The cause was thought to be atrial flutter from newly started flecainide. He also underwent angiography and had stents inserted to the left circumflex and right coronary arteries.