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A fully upright P-wave is typical atrial activity of atrialflutter as seen in V1. See these example cases of upright P-waves: Case Continued Thus, I was all but certain that this was atrialflutter. IV Digoxin may begin to slow the ventricular response of AFib or AFlutter sooner than many clinicians realize.
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.
The ECG was interpreted as showing atrialflutter with 2:1 conduction. The heart rate could be compatible with that of a 2:1 conducted atrialflutter. Also, lead I could give the initial impression of showing flutter waves. She presented to the emergency department after a couple of days of chest discomfort.
P utting I t A ll T ogether : — The Rhythm in Figure-1 What we have just described is the following: A regular WCT ( = W ide- C omplex T achycardia ) at a rate very close to 300/minute — without clear sign of atrial activity. Among the fast Supraventricular Rhythms: This is not AFib — because the rhythm is regular.
So this is an extremely slow atrialflutter with 2:1 conduction. Atrial rate 146, ventricular rate 73. I suspect that the amyloid slows the conduction of the atrialflutter. It turned out that he had a history of slow atrialflutter. Atrial arrhythmias ( especially AFib or AFlutter ).
of all cases, and 62% of Veritas® misdiagnoses). == MY Comment , by K EN G RAUER, MD ( 1/5/2020 ): == This case illustrates a number of important teaching points. M Y A NSWER: In my experience, MAT is the 2nd-most commonly overlooked cardiac arrhythmia ( surpassed only by AtrialFlutter ). GET a 12-lead!
There is atrial activity before every QRS, but that activity has negative polarity, so it is not sinus rhythm. There are clearly no flutter waves, so it is not atrialflutter (a "macro-reentrant" atrial tachycardia) Is it AVNRT originating at the superior pole of the AV node, resulting in a retrograde P-wave before the QRS?
Note: The ECG in Figure-1 was initially recorded using the Cabrera Format ( See Comment by Dr. Grauer at the bottom of the page in the October 26, 2020 post for review of the Cabrera Format ). Figure-2: Colored arrows highlight flutter waves , with 2:1 AV conduction. The AFib had been well controlled on Flecainide for many years.
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