This is a good example of atrial flutter with variable conduction in a 53-year-old man. He had been treated for a fast rate, and now has a rate of approximately 90 per minute. No other clinical information is available. One of the good teaching points in this ECG is that some leads show P waves (or, in this case, flutter waves) better than others. The diagnosis of atrial flutter can be missed by practitioners utilizing only one or two leads.
Atrial flutter with variable conduction
This is a good teaching strip for showing your students how to "see" the atrial activity separately from the ventricular activity. The P waves, also called flutter waves, march out regularly at a rate of around 300/minute, which is typical of atrial flutter. The conduction ratio is variable, and the intervals between the conducted P waves and the QRS complexes vary, as well, reflecting changing refractoriness of the AV node.
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