ECG OF THE WEEK.

PROF .DR.P.VIJAYARAGHAVAN’S UNIT.

DR.A.KARTHICK RAMALINGAM.

Clinical summary.

• 70 year old Mrs. Devasundari was admitted with

C/o Chest pain, Palpitation,

ECG FINDINGS

• Atrial rate 340/min• Ventricular Rate 60/ min.• Axis +60.• P waves having morphology intermediate

between that of flutter and fibrillation waves.

• Rhythm strip shows flutter/fibrillation waves • No ST , T wave abnormalities seen .• IMP: – Flutter - fibrillation– Atrial flutter is of type I . (Flutter waves are of

uniform morphology)– Clockwise conduction. (Positive F wave II,III,aVF).

Atrial flutter

• It’s a supraventricular tachycardia caused by reentrant rhthym either in left or right atrium.

• Atrial rate will be around 240 to 400/ min.• Two types: Type 1 or classic form is more common.

Involves a single reentrant circuit . Type II (atypical) Atypical atrial flutters .

Has a rate faster than type I

TYPE I FLUTTER

TYPE I FLUTTER

Anticlockwise and Clockwise

OTHER REENTRANT CIRCUITS

Treatment

• General goals for the treatment of symptomatic atrial flutter are similar to those for atrial fibrillation and include the following:

• Control of the ventricular rate• Restoration of sinus rhythm• Prevention of recurrent episodes, or decrease in

their frequency or duration• Prevention of thromboembolic complications• Minimization of adverse effects from therapy

TYPE I FLUTTER• If pt is clinically stable : consider ventricular rate

control and elective ablative therapy of the circuit.

• If pt is hemodynamically compromised : cardioversion immediately or after anticoagulation depending on duration of A. flutter followed by elective abalative therapy. ELECTRICAL CARDIOVERSION IS PREFFERED

• Post ablation pt may or maynot nead antiarrythymics depending on effectiveness of ablation.

TYPE II FLUTTER

• Ablation can be done in higher centers with facilities to map the circuit .

CATHETER ABLATION

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