Skip to main content

Atrial tachycardia or atrial flutter

Educational post

Please have a look at the ECG shown below.

Is this atrial tachycardia or atrial flutter?


ECG definition of atrial flutter is atrial rate more than 240 bpm and no isoelectric line between p waves.
Atrial tachycardia will have rate between 120 to 240 bpm with clear isoelectric line between p waves.

However, these two ECG criteria are not specific for any of them.
Atrial tachycardia with higher heart rate is possible and atrial flutter with lower heart rate is possible.
Atrial flutter may have an isoelectric line between p waves because of atriotomy scars causing conduction block.

More important is to identify mechanism of atrial tachycardia during electrophysiological study.
Electrophysiological study gives us a better idea regarding mechanism of atrial tachycardia.

Atrial tachycardia can be focal or macroreentrant. Focal can be because of automaticity, triggered activity or microreentrant cause.

Coming to this case, Here, atrial rate is around 250 / min and there is isoelectric line between two p waves. So, this falls under grey area as per the ECG definition. I would call it atrial tachycardia with slightly higher atrial rate. Some people may call it atypical atrial flutter. Here, terminology doesn’t make a difference on management. However, it is important to recognise that this is not typical atrial flutter.

Comments

Popular posts from this blog

ECG Spotter

What is the diagnosis? Click the button below to view answer: Show Answer

MCQ

 Cardiology MCQ Q. Which of the following leads is not an inferior lead in ECG? A. Lead II B. Lead III C. Lead aVF D. Lead aVR Click the button below to view answer Show answer Correct answer is option D. Lead aVR

Coronary artery perforation

  Management of coronary artery perforation 1.       Balloon inflation for occlusion of vessel 2.       General circulatory support → Intravenous fluids and vasopressors 3.       Urgent pericardiocentesis if cardiac tamponade (may consider autotransfusion) 4.       Call anaesthetist and inform surgeons. Repeat angiogram ↓ Extravasation settled → Yes → Monitor patient ↓ No #        Large vessel perforation 1.       Prolonged balloon inflation 2.       Covered stent placement #        Small distal vessel perforation 1.       Embolization (fat, coils, thrombin, balloon fragment) 2.       Covered stent in main vessel over perforated branch origin