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To me, it was clearly atrialflutter with 1:1 conduction. The rate of 280 is just right for atrialflutter. The waves look like atrialflutter waves, NOT like a wide ventricular complex. Reverted to atrial fibrillation with RVR while in the hospital 3 times and needed cardioversion.
PEARL # 3: AtrialFlutter with 1:1 AV conduction is rare! Since the rate of atrial activity with flutter in adults is most often very close to 300 /minute ( ie, usual range for atrial activity ~250-350/minute ) — AFlutter with 2:1 AV conduction typically results in a regular ventricular rate of ~140-160/minute.
Annals of Emergency Medicine 2012; 60(12):766-776. LAFB, atrialflutter, anterolateral STEMI(+) OMI. Diagnosis of Acute Myocardial Infarction in the Presence of Left Bundle Branch Block using the ST Elevation to S-Wave Ratio in a Modified Sgarbossa Rule. South African flag pattern, plus precordial swirl pattern.
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