Atrial Fibrillation and Flutter

Atrial Flutter

Definition

Atrial flutter is a tachyarrhythmia arising above the AV node with an atrial rate of 250-350 bpm

Features

Atrial flutter is due to a large reentrant circuit confined to the right atrium in over 85% of cases

ECG Characteristics

Negative sawtooth flutter waves in leads II, III, and AVF. AV conduction most commonly is 2:1, which yields a ventricular rate of approximately 150 bpm

Significance

Commonly is observed in patients with ischemic heart disease, myocardial infarction, cardiomyopathy, myocarditis, pulmonary embolus, toxic ingestion (eg, alcohol), or chest trauma


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Atrial Flutter with 2:1 Conduction

ECG of Atrial Flutter with 2:1 Conduction

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Atrial Fibrillation

Definition

Arrhythmia arising from chaotic atrial depolarization

Features

The atria contract irregularly and very rapidly producing variable R-R intervals

ECG Characteristics

An irregular rhythm with fibrillatory atrial activity. No regular P waves are identifiable and the baseline is undulating. The ventricular response may be slow (<60), normal (60-100), or rapid (>100). The ventricular rate may be 170 bpm or higher

Significance

AF is an extremely common rhythm associated with rheumatic heart disease, hypertension, ischemic heart disease, pericarditis, thyrotoxicosis, alcohol intoxication, mitral valve prolapse, and digitalis toxicity


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Atrial Fibrillation with Moderate Ventricular Response

ECG of Atrial Fibrillation with Moderate Ventricular Response

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Atrial Fibrillation with Rapid Ventricular Response

ECG of Atrial Fibrillation with Rapid Ventricular Response

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