Atrial Flutter is a supra ventricular tachycardia , it mean that narrow complex QRS tachycardia like other supra ventricular tachycardia except aberrant conduction withe wide complex .
This arrhythmia cause by a circuit reentrant around the tricuspide valve in the right atrium.
Like other SVT the re-entrant circuit is initiated by premature atrial beat cause some part of the circuit in refractory state and other can conduce the electrical impulse, so this part conduce to the refractory area that just recovery, so it form the cycle of conduction and this conduction turn over and over to make the circuit of re-entrant ,this circuit conduce the fast rate of electrical signal so it cause fast atrial activity that we see on surface ECG rapid atrial activity (many many P wave).
This figure show you the re entrant of Atrial flutter locate
at the right atrial compare to Atrial fibrillation that is chaos electrical
activity in both atriums. and also show the direction of the re entrant
that counterclockwise direction,that will show P wave invert in DII DII AVF and
up right in V1, that we called typical flutter. In contrast if the
direction ogf the circuit is clockwise we call atypical flutter result in
P wave positive in DII DIII AVF and negative in V1.
Here EKG show the typical and atypical flutter
The most common rate of atrial flutter with atrial rate
around 300 per minute and the conduction throw the AV node with 2:1 ratio
result in ventricular rate about 150 beats per minute . Like that the
ventricular rate depend on AV node conduction it can 2:1,3:1or 4:1 or can be
greater with 1:1 conduction that cause very fast ventricular rate.
The typical and atypical flutter can occur in same patient
Voila the atrial flutter
criteria
1 . rate : Atrial rate 250-350 bpm,
Ventricular rate variable (depend on AV conduction )
2 .Rhythm : Atrial regular
, Ventricular variable (depend on AV conduction )
3 .P wave : Flutter wave ''saw toothed
appearance''
4 .PR interval : Variable
5 .QRS :
Narrow , wide if F wave buried in QRS
The ECG
C, D show Atrial flutter with atrial rate about 300 per minute with variable conduction result in irregularly irregular RR interval
A : show the constant conduction of AV node 2:1 ration and regular of RR interval.
B : show the irregular regular conduction
This EKG show atrial flutter with 2:1 conduction, and
flutter with 1:1 ratio conduction result in very fast of ventricular rate
Another cases Please try to interpretation all EKG below
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