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Physiologically — the most commonly observed pattern of AFlutter, known as " Typical " AFlutter — produces 2:1 negative deflections seen in the inferior leads ( as seen in Figure-3 ) — as a result of CCW ( C ounter C lock W ise ) rotation of a fixed reentrant circuit around the tricuspid valve annulus and through the cavo-tricuspid isthmus.
In the new image on the right, it no longer turns upward within the atrium, but continues distally into the tricuspid valve or ventricle. This is supported by the PT note which described a palpably irregular pulse with pauses and marked bradycardia. In the old x-ray on the left, the lead appears to terminate within the atrium.
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