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Atrial Flutter Atrial Flutter with Variable Conduction (Example 1) Atrial Flutter with Variable Conduction (Example 2) Atrial Flutter with Variable Conduction (Example 3) Atrial Flutter with 2:1 Conduction (Example 1) Atrial Flutter with 2:1 Conduction (Example 2) Atrial Flutter with 3:1 Conduction (Example 1) Atrial Flutter with 4:1 Conduction (Example 1) Atrial Flutter with 4:1 Conduction (Example 2) Atrial Flutter with 4:1 Conduction (Example 3) Atrial Flutter with 5:1 Conduction (Example 1) Atrial Flutter with 5:1 Conduction (Example 2) Atrial flutter occurs when a "reentrant circuit" is present causing a repeated loop of electical activity to depolarize the atrium at rate of about 300-400 (remember the atrial rate in atrial fibrillation is 400-600). This produces a characteristic "sawtooth" pattern of the P waves, unlike atrial fibrillation in which the atrial rate is so fast that the P waves are not identifiable. Just as in atrial fibrillation, not all of the P waves are able to conduct through the AV node. Thus the ventricular rate will not be as fast as the atrial rate. Typically, the atrial rate will be about 300 per minute and only every other atrial depolarization will be conducted through the AV node. In this situation, the ventricular (QRS) rate will be exactly 150 beats per minute. Clinical Pearl: A narrow comlpex tachycardia at a ventricular rate of exactly 150 beats per minute is very commonly atrial flutter. Atrial flutter with variable conduction of the P waves can also occur. In this situation there may be 3 P waves to 1 QRS complex, then a quick change to 2 P waves to 1 QRS complex etc. Any combination of P waves to QRS complexes can occur. |
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