Atrial flutter electrocardiogram: Difference between revisions
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{{Atrial flutter}} | {{Atrial flutter}} | ||
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}} | {{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}} | ||
==Overview== | ==Overview== | ||
Characteristic electrocardiographic findings in a patient with atrial flutter include; an atrial rate from 250-350 beats per minute, a "sawtooth" appearance to the tracings due to rapid regular undulations (F waves), and a variable ventricular rate depending on AV conduction. | Characteristic [[Electrocardiogram|electrocardiographic]] findings in a patient with atrial flutter include; an atrial rate from 250-350 beats per minute, a "sawtooth" appearance to the tracings due to rapid regular undulations (F waves), and a variable ventricular rate depending on AV conduction. | ||
==Electrocardiogram== | ==Electrocardiogram== | ||
Findings on an ECG suggestive of atrial flutter include: | Findings on an [[ECG]] suggestive of atrial flutter include: | ||
*There are rapid regular undulations (F waves) that cause a sawtooth appearance. | *There are rapid regular undulations (F waves) that cause a sawtooth appearance. | ||
** Best seen in leads [[Electrocardiogram#Limb|II]], [[Electrocardiogram#Limb|III]], [[Electrocardiogram#Augmented limb|aVF]] and [[Electrocardiogram#Precordial|V1]]. | ** Best seen in leads [[Electrocardiogram#Limb|II]], [[Electrocardiogram#Limb|III]], [[Electrocardiogram#Augmented limb|aVF]] and [[Electrocardiogram#Precordial|V1]]. | ||
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** No isoelectric baselines between the F waves. | ** No isoelectric baselines between the F waves. | ||
*Atrial rate is 250 to 350 Beats Per Minute (BPM). | *[[Atrial]] rate is 250 to 350 Beats Per Minute (BPM). | ||
** Can be faster in infants and children. | ** Can be faster in infants and children. | ||
** Massive dilation of the atria can lead to a rate < 200 BPM. | ** Massive dilation of the atria can lead to a rate < 200 BPM. | ||
** [[Quinidine]] can reduce the atrial rate. | **[[Quinidine]] can reduce the [[atrial]] rate. | ||
*There is a variable ventricular rate depending on the AV conduction. | *There is a variable ventricular rate depending on the AV conduction. | ||
** The most common response is 2:1 | ** The most common response is 2:1. | ||
** 3:1 is uncommon | ** 3:1 is uncommon. | ||
** 4:1 suggests the existence of an AV conduction defect | ** 4:1 suggests the existence of an AV conduction defect | ||
** May be associated with [[complete AV block]] in which case the RR intervals are regular and the F waves have no constant relationship to the [[QRS]]. The ventricular response is usually slow. | ** May be associated with [[complete AV block]] in which case the [[RR interval|RR intervals]] are regular and the F waves have no constant relationship to the [[QRS]]. The [[ventricular]] response is usually slow. | ||
** 1:1 conduction may be precipitated by excitement, exercise, induction of [[anesthesia]] or any increase in sympathetic tone. | ** 1:1 conduction may be precipitated by excitement, exercise, induction of [[anesthesia]] or any increase in sympathetic tone. | ||
*It may occur in [[WPW]] where the impulses are conducted antegrade through the bypass tract. All these are an emergency. | *It may occur in [[WPW]] where the impulses are conducted antegrade through the bypass tract. All these are an emergency. | ||
** During treatment with [[quinidine]] the atrial rate may slow sufficiently to permit 1:1 conduction. | ** During treatment with [[quinidine]] the [[atrial]] rate may slow sufficiently to permit 1:1 conduction. | ||
** Vagal maneuvers increase the degree of [[AV block]]. | **[[Vagal maneuvers]] increase the degree of [[AV block]]. | ||
*QRS either normal or aberrant depending on preexisting [[IVCD]] or aberrant ventricular conduction. | *[[QRS complex]] either normal or aberrant depending on preexisting [[IVCD]] or aberrant ventricular conduction. | ||
==EKG Examples== | ==EKG Examples== | ||
Revision as of 17:12, 4 December 2019
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Atrial flutter electrocardiogram On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Characteristic electrocardiographic findings in a patient with atrial flutter include; an atrial rate from 250-350 beats per minute, a "sawtooth" appearance to the tracings due to rapid regular undulations (F waves), and a variable ventricular rate depending on AV conduction.
Electrocardiogram
Findings on an ECG suggestive of atrial flutter include:
- There are rapid regular undulations (F waves) that cause a sawtooth appearance.
- Atrial rate is 250 to 350 Beats Per Minute (BPM).
- There is a variable ventricular rate depending on the AV conduction.
- The most common response is 2:1.
- 3:1 is uncommon.
- 4:1 suggests the existence of an AV conduction defect
- May be associated with complete AV block in which case the RR intervals are regular and the F waves have no constant relationship to the QRS. The ventricular response is usually slow.
- 1:1 conduction may be precipitated by excitement, exercise, induction of anesthesia or any increase in sympathetic tone.
- It may occur in WPW where the impulses are conducted antegrade through the bypass tract. All these are an emergency.
- During treatment with quinidine the atrial rate may slow sufficiently to permit 1:1 conduction.
- Vagal maneuvers increase the degree of AV block.
- QRS complex either normal or aberrant depending on preexisting IVCD or aberrant ventricular conduction.
EKG Examples
Shown below is an EKG with an alternating 2:1 and 3:1 atrial flutter.
Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/File:Aflutr_ecg.jpg
Shown below is an EKG depicting atrial flutter.
Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/Main_Page
Shown below is an EKG of a 2:1 atrial flutter.
Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/File:ECG_Aflutt.jpg
Shown below is an EKG of a 2:1 atrial flutter.
Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/Main_Page
- For more EKG examples of atrial flutter click here.