Why is this left atrial atypical atrial flutter (ECG 1)? Atrial fibrillation can be excluded because nice flutter waves (all look the same) can be clearly identified. With typical right atrial flutter, the reentry circle runs counterclockwise and we see typical saw tooth patterns in the inferior leads (negative flutter waves). The flutter waves are positive in V1 (ECG 2). With typical right atrial flutter with a clockwise reentry circle, the flutter waves in the inferior leads are positive.

This Holter-ECG comes from a 70-year-old physician with coronary artery disease. He is twelve months after PCI (RCA, RCX). Currently no symptoms (no dyspnea, no chestpain, no palpitations). You can see that an overview/section from a Holter- EKG, 3 channels are shown, strip width is 30 seconds. First you can see a sinus rhythm with frequent PVCs, then there is a transition to an accelerated idioventricular rhythm (AIVR) that lasts almost a minute in total. 

This ECG is from an 80-year-old lady who has collapsed or had sycopal episodes several times. The ECG comes from a Holter monitor. She has arterial hypertension and coronary artery disease. The ECG shows a second-degree, Mobitz Type II AV block. In both types of AVB, the PP intervals are usually the same.

Welcome to Dr. Andreas Roeschl, who is a cardiologist and ECG instructor in Germany.  He will have a recurring blog on the Guru, contributing his knowledge about ECG and teaching, along with ECGs from his collection.  His ECGs are digitized and beautiful quality for reproduction, and his contributions will be a great asset to any student or teacher of ECG.  Dr. Ken Grauer and I want you to feel free to ask us and Dr. Roeschl any questions you have about ECG or teaching ECG.  That is the mission of this website - to make it easier for instructors to teach.