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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.
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. After atrial rhythm/SR was restored the patient slowly improved.
The differential of a regular narrow QRS tachycardia is sinus tachycardia, SVT, and atrialflutter with regular conduction. There are no P waves preceding the QRS complexes, and no clear flutter waves. There is no need to immediately refer today’s patient to EP for ablation. She had an echocardiogram which was normal.
Atrialflutter with 2:1 conduction. The atrialflutter rate is approximately 200 bpm, with 2:1 AV conduction resulting in ventricular rate almost exactly 100 bpm. Further history revealed she had new onset atrialflutter soon after her aortic surgery, and was put on flecainide approximately 1 month ago.
The patient has been scheduled for a PVC ablation procedure. Our patient was referred for EP study with a plan of PVC ablation if possible. The various idiopathic VTs usually can be controlled well with medical treatment and/or catheter ablation therapy. 2022, September 2) [2] Ward, R. Van Zyl, M., & 3] Lavalle, C.
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