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The rhythm is sinus bradycardia at a rate just over 50/minute. The February 11, 2020 post ( LA-RA reversal ). The March 18, 2020 post ( LA-RA reversal ). The July 28, 2020 post ( RA-LL reversal ). The August 28, 2020 post ( LA-LL reversal ). The November 19, 2020 post ( LA-LL reversal ).
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.
The physiologic reason for this — is thought to be the result of momentarily increased circulation from mechanical contraction arising from the "sandwiched in" QRS complex. The QRS complex in ECG #1 is wide. Figure-3: Diagnostic considerations for a patient who presents in AV block ( adapted from Mangi et al — StatPearls, 2021 ).
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