Remove AFIB Remove Atrial Flutter Remove Blog
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ECG Cases 28 Approach to Atrial Fibrillation

ECG Cases

Jesse McLaren explains his AFIB mnemonic for approach to atrial fibrillation that involves 4 questions: 1. Is it atrial fibrillation? If it is atrial fibrillation and there is rapid ventricular response, is it fast from a secondary cause? Does the patient need an anticoagulant started in the ED?

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Wide Complex Tachycardia -- VT, SVT, or A Fib with RVR? If SVT, is it AVNRT or AVRT?

Dr. Smith's ECG Blog

male with pertinent past medical history including Atrial fibrillation, atrial flutter, cardiomyopathy, Pulmonary Embolism, and hypertension presented to the Emergency Department via ambulance for respiratory distress and tachycardia. Now you CAN on occasion see PVCs during reentry SVTs that do not convert the SVT.

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Wide-complex tachycardia: VT, aberrant, or "other?"

Dr. Smith's ECG Blog

Instead, the rate of 150, plus the history of AF, suggested atrial flutter. A close inspection of lead II showed P or flutter waves at a rate of about 300 bpm, also supporting atrial flutter. There appear to be flutter waves at a rate of 300. Flecainide encourages new atrial flutter.

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Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.

Dr. Smith's ECG Blog

The rhythm differential for narrow, regular, and tachycardic is sinus rhythm, SVT (encompassing AVNRT, AVRT, atrial tach, etc), and atrial flutter (another supraventricular rhythm which is usually considered separately from SVTs). Therefore this patient is either in some form of SVT or atrial flutter. If so, why?

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Wide-complex tachycardia that didn’t follow the rules

Dr. Smith's ECG Blog

The WCT is interrupted by a series of variable-morphology QRS complexes, with atrial flutter waves note in II, III, and aVF. Detail of Flutter waves The rate of the flutter waves matches the rate of the WCT (about 200/m), proving that the presenting WCT had been 1:1 atrial flutter.

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ECG Blog #368 — Why So Fast?

Ken Grauer, MD

NOTE: The ECG in Figure-1 has been recorded at the usual 25mm/second speed — but with the Cabrera format ( Please see my Editorial Note near the top of the page in ECG Blog #365 for review of the basics of this recording system ). Among the fast Supraventricular Rhythms: This is not AFib — because the rhythm is regular.

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New Onset Heart Failure and Frequent Prolonged SVT. What is it? Management?

Dr. Smith's ECG Blog

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 atrial flutter (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?