ECG Guru - Instructor Resources - Atrial flutter https://www.ecgguru.com/ecg/atrial-flutter-0 en Atrial Flutter With Right Bundle Branch Block and Left Anterior Fascicular Block In a Patient With Preexisting RBBB + LAFB https://www.ecgguru.com/blog/atrial-flutter-right-bundle-branch-block-and-left-anterior-fascicular-block-patient-preexisting <div class="field field-name-field-blog-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/blog/atrial-flutter-right-bundle-branch-block-and-left-anterior-fascicular-block-patient-preexisting"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/RSB%20und%20LAH.jpg" width="3297" height="1784" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>If a wide complex tachycardia occurs, the probability is very high that it is a ventricular tachycardia (approx. 80%, in patients with a previous myocardial infarction (...) approx. 90%). Here we see a broad complex tachycardia that looks like an RBBB + LAFB, which is regular. In this constellation, 3 causes must be considered:<br /> 1. fascicular tachycardia from the left posterior fascicle of the left tawara fascicle (QRS width usually only around 130 ms, but sometimes significantly longer).<br /> 2. AT/AFL with 2:1 conduction in the case of pre-existing bifascicular block<br /> 3. AT/ AFL with 2:1 conduction in the case of functional bifascicular block (i.e. first generated by the tachycardia) </p> <p>In this ECG, it is very difficult to recognize atrial activity. After electrical cardioversion of the existing atrial flutter with 2:1 conduction in this case, this patient showed a picture of SR with RBBB + LAFB.</p> </div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/58/feed" method="post" id="fivestar-custom-widget" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--2" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Atrial Flutter With Right Bundle Branch Block and Left Anterior Fascicular Block In a Patient With Preexisting RBBB + LAFB 1/5</option><option value="40">Give Atrial Flutter With Right Bundle Branch Block and Left Anterior Fascicular Block In a Patient With Preexisting RBBB + LAFB 2/5</option><option value="60">Give Atrial Flutter With Right Bundle Branch Block and Left Anterior Fascicular Block In a Patient With Preexisting RBBB + LAFB 3/5</option><option value="80" selected="selected">Give Atrial Flutter With Right Bundle Branch Block and Left Anterior Fascicular Block In a Patient With Preexisting RBBB + LAFB 4/5</option><option value="100">Give Atrial Flutter With Right Bundle Branch Block and Left Anterior Fascicular Block In a Patient With Preexisting RBBB + LAFB 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.7</span></span> <span class="total-votes">(<span >3</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-vsxN0WjCtf0Z7URFVOwKG1NuSuNC-xIYVThmkaBVoTI" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fblog%2Fatrial-flutter-right-bundle-branch-block-and-left-anterior-fascicular-block-patient-preexisting&amp;title=Atrial%20Flutter%20With%20Right%20Bundle%20Branch%20Block%20and%20Left%20Anterior%20Fascicular%20Block%20In%20a%20Patient%20%20With%20Preexisting%20RBBB%20%2B%20LAFB"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></span></li> </ul> Mon, 18 Dec 2023 17:14:52 +0000 Dr A Röschl 888 at https://www.ecgguru.com https://www.ecgguru.com/blog/atrial-flutter-right-bundle-branch-block-and-left-anterior-fascicular-block-patient-preexisting#comments Atrial Flutter Degenerates Into Atrial Fibrillation https://www.ecgguru.com/blog/atrial-flutter-degenerates-atrial-fibrillation <div class="field field-name-field-blog-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/blog/atrial-flutter-degenerates-atrial-fibrillation"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/FLattern%20wird%20zu%20Flimmern.jpg" width="2275" height="1422" alt="" /></a></div><div class="field-item odd"><a href="/blog/atrial-flutter-degenerates-atrial-fibrillation"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/agree.jpg" width="2682" height="1710" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>Atrial flutter and atrial fibrillation are two different cardiac arrhythmias, but occur frequently side by side in the same patient. Here is an example of how atrial flutter degenerataes into atrial fibrillation. The initially ordered atrial activity (left in the picture) with 2 flutter waves/1 QRS complex changes into irregular atrial activity (right in the picture) and the RR intervals become completely irregular.</p> </div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/58/feed" method="post" id="fivestar-custom-widget--2" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--4" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Atrial Flutter Degenerates Into Atrial Fibrillation 1/5</option><option value="40">Give Atrial Flutter Degenerates Into Atrial Fibrillation 2/5</option><option value="60">Give Atrial Flutter Degenerates Into Atrial Fibrillation 3/5</option><option value="80">Give Atrial Flutter Degenerates Into Atrial Fibrillation 4/5</option><option value="100" selected="selected">Give Atrial Flutter Degenerates Into Atrial Fibrillation 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.5</span></span> <span class="total-votes">(<span >2</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--2" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-QvT5hAxne6xUMsNy0tFjER2WbbajJY1XAxSSpxxVL2Q" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_2"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fblog%2Fatrial-flutter-degenerates-atrial-fibrillation&amp;title=Atrial%20Flutter%20Degenerates%20Into%20Atrial%20Fibrillation"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Mon, 11 Dec 2023 06:43:37 +0000 Dr A Röschl 885 at https://www.ecgguru.com https://www.ecgguru.com/blog/atrial-flutter-degenerates-atrial-fibrillation#comments Atypical Atrial Flutter (From the Left Atrium) https://www.ecgguru.com/blog/atypical-atrial-flutter-left-atrium <div class="field field-name-field-blog-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/blog/atypical-atrial-flutter-left-atrium"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/atypical%20leftatrial%20flutter.jpg" width="3236" height="1712" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>Why is this atypical atrial flutter from the left atrium?<br /> We see a regular rhythm with narrow QRS complexes and a heart rate of approx. 75 bpm. Between 2 QRS complexes we see 4 atrial actions, so the atrial rate is about 300 bpm. At such high heart rates, we no longer speak of atrial tachycardia but of atrial flutter. How can the left atrial origin be derived? Lead I goes from the right to the left arm, with the positive electrode on the left arm. If the direction of excitation of the atria is the same as the vector of the lead, (toward the positive electrode), you see a positive flutter wave. So, when the atria are depolarizing from right to left, Lead I will have upright P waves. When the atrial flutter is from the left atrium, Lead I will have negative P waves. Since Lead V1 is on the patient's right side, it is the other way around: V1 will often (not always) have negative flutter waves with right atrial flutter, positive flutter waves with left atrial flutter.<br /> If these findings are applied to this ECG, then it is clear that it must be left atrial flutter.</p> </div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/58/feed" method="post" id="fivestar-custom-widget--3" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--6" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Atypical Atrial Flutter (From the Left Atrium) 1/5</option><option value="40">Give Atypical Atrial Flutter (From the Left Atrium) 2/5</option><option value="60">Give Atypical Atrial Flutter (From the Left Atrium) 3/5</option><option value="80">Give Atypical Atrial Flutter (From the Left Atrium) 4/5</option><option value="100" selected="selected">Give Atypical Atrial Flutter (From the Left Atrium) 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >5</span></span> <span class="total-votes">(<span >1</span> vote)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--3" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-6-xv1fol1iw1PeZDxP9nVOTe2scBgxK1P9kKmqekgrA" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_3"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fblog%2Fatypical-atrial-flutter-left-atrium&amp;title=Atypical%20%20Atrial%20Flutter%20%28From%20the%20Left%20Atrium%29"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Mon, 13 Nov 2023 14:07:44 +0000 Dr A Röschl 878 at https://www.ecgguru.com https://www.ecgguru.com/blog/atypical-atrial-flutter-left-atrium#comments Atypical Atrial Flutter https://www.ecgguru.com/blog/atypical-atrial-flutter <div class="field field-name-field-blog-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/blog/atypical-atrial-flutter"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/atypisches%20linksatriales%20Vorhofflattern_0.jpg" width="2786" height="1900" alt="" /></a></div><div class="field-item odd"><a href="/blog/atypical-atrial-flutter"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/typical%20atrial%20flutter%20counterclockwise_0.jpg" width="2843" height="1900" alt="" /></a></div><div class="field-item even"><a href="/blog/atypical-atrial-flutter"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/typical%20atrial%20flutter%20clockwise_0.jpg" width="2840" height="1909" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>Why is this left atrial atypical atrial flutter (<strong>ECG 1</strong>)? 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 (<strong>ECG 2</strong>). With typical right atrial flutter with a clockwise reentry circle, the flutter waves in the inferior leads are positive. In V1 they are variable and show typically a w-shaped pattern (<strong>ECG 3</strong>). There is no zeroline between the flutter waves in both forms in the inferior leads (reentry circle!)</p> <p>In this ECG, showing left atrial atypical atrial flutter, the flutter waves in lead I are negative. Lead I goes from the right to the left arm, with the positive pole on the left arm.&nbsp; So the vector of the lead is opposite to the direction of spread of the flutter waves. So the flutter waves travel from left to <em>right,</em> away from the positive electrode. A zeroline can be seen between the flutter waves in nearly all leads (focal origin!) It is not always possible to discern the different forms of atrial flutter in a 12 lead ECG.</p> </div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/58/feed" method="post" id="fivestar-custom-widget--4" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--8" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Atypical Atrial Flutter 1/5</option><option value="40">Give Atypical Atrial Flutter 2/5</option><option value="60">Give Atypical Atrial Flutter 3/5</option><option value="80">Give Atypical Atrial Flutter 4/5</option><option value="100">Give Atypical Atrial Flutter 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="empty">No votes yet</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--4" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-PQWttvwgr0-96P0BfpQ98IbZgXYpXWmFJrnXyVCY59Y" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_4"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fblog%2Fatypical-atrial-flutter&amp;title=Atypical%20Atrial%20Flutter"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Fri, 02 Jun 2023 11:47:51 +0000 Dr A Röschl 846 at https://www.ecgguru.com https://www.ecgguru.com/blog/atypical-atrial-flutter#comments ECG Basics: Atrial Flutter With 2:1 Conduction And An Aberrantly-conducted Beat https://www.ecgguru.com/ecg/ecg-basics-atrial-flutter-21-conduction-and-aberrantly-conducted-beat <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/ecg-basics-atrial-flutter-21-conduction-and-aberrantly-conducted-beat"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/155%20AFL%202%20to1%20w%20Aberrant%20beat%20MR111.jpg" width="1800" height="410" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This strip was taken from a patient at rest. &nbsp;It shows a regular tachycardia with a slightly-widened QRS complex at about .10 seconds duration. &nbsp;It is somewhat difficult to evaluate the baseline for P waves or flutter waves. &nbsp;We ALWAYS recommend multi-lead assessment for such evaluation. &nbsp;The P waves (or flutter waves) here have a sharp point, and can be easily "marched out", with a rate of about 300 per minute.</p><p>Whenever the ventricular rate is near 150/min., we should always consider the possibility of atrial flutter with 2:1 conduction. &nbsp;Since atrial flutter results in atrial depolarization at around 250 - 350 per minute, conducting every other P wave results in a rate of about 150. &nbsp;It can masquerade as sinus tach, but a patient with sinus tach at such a fast rate would probably have an obvious cause for a rapid heart rate, such as hypovolemia, drug overdose, or exertion. &nbsp;This rhythm could also be mistaken for atrial tachycardia or other forms of supraventricular tachycardia (SVT, PSVT, AVNRT, etc.). &nbsp; Multiple leads can more easily uncover the flutter waves running continuously "behind" and "through" the QRS complexes.</p><p>There is one beat that is obviously different from the others. &nbsp;This beat is about the same width as the other QRS complexes, but is opposite in direction. &nbsp;This probably represents aberrant conduction, possibly a hemiblock that occurs only in this beat. &nbsp;Careful measurement will show that this QRS is very slightly early, while the others are all very regular. The slight width of all the QRS complexes suggests that there is a conduction delay, which cannot be diagnosed on one strip with no patient history available.</p><p>There are other differential diagnoses, such as ventricular tachycardia with a captured sinus beat. &nbsp;We welcome discussion of this interesting strip.&nbsp;</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/58/feed" method="post" id="fivestar-custom-widget--5" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--10" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give ECG Basics: Atrial Flutter With 2:1 Conduction And An Aberrantly-conducted Beat 1/5</option><option value="40">Give ECG Basics: Atrial Flutter With 2:1 Conduction And An Aberrantly-conducted Beat 2/5</option><option value="60">Give ECG Basics: Atrial Flutter With 2:1 Conduction And An Aberrantly-conducted Beat 3/5</option><option value="80" selected="selected">Give ECG Basics: Atrial Flutter With 2:1 Conduction And An Aberrantly-conducted Beat 4/5</option><option value="100">Give ECG Basics: Atrial Flutter With 2:1 Conduction And An Aberrantly-conducted Beat 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4</span></span> <span class="total-votes">(<span >2</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--5" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-YEmUguKXfV6ODzhKayz8fUQaAucixNQdUmINN-pvB5Q" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/atrial-flutter-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial flutter</a></div><div class="field-item odd"><a href="/ecg/atrial-flutter-21-conduction-1" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial flutter with 2:1 conduction</a></div><div class="field-item even"><a href="/ecg/basic-ecg" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Basic ECG</a></div><div class="field-item odd"><a href="/ecg/aberrant-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Aberrant conduction</a></div><div class="field-item even"><a href="/ecg/fusion-beat" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Fusion beat</a></div><div class="field-item odd"><a href="/ecg/rhythm-strip" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Rhythm strip</a></div><div class="field-item even"><a href="/ecg/ecg-basics" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ECG Basics</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_5"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fecg-basics-atrial-flutter-21-conduction-and-aberrantly-conducted-beat&amp;title=ECG%20Basics%3A%20%20Atrial%20Flutter%20With%202%3A1%20Conduction%20And%20An%20Aberrantly-conducted%20Beat"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sun, 23 Aug 2015 18:20:06 +0000 Dawn 658 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-basics-atrial-flutter-21-conduction-and-aberrantly-conducted-beat#comments Atrial Flutter With Variable Conduction https://www.ecgguru.com/ecg/atrial-flutter-variable-conduction-2 <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/atrial-flutter-variable-conduction-2"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/MR100%20Atrial%20Flutter%20Variable%20Cond%20Ratio.jpg" width="1800" height="1346" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This is a good example of atrial flutter with variable conduction in a 53-year-old man. &nbsp;He had been treated for a fast rate, and now has a rate of approximately 90 per minute. &nbsp;No other clinical information is available. &nbsp;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. &nbsp;The diagnosis of atrial flutter can be missed by practitioners utilizing only one or two leads.</p><p>The typical flutter waves, at a rate close to 300 / min., can best be seen in Leads II, III, aVF, aVL, V1, and V3. &nbsp; Leads II and aVF are especially good for teaching students to "march out" the flutter waves through the entire strip. &nbsp;They can be seen in the QRS complexes and T waves in these leads.</p><p>Because atrial flutter often accompanies a diagnosis of congestive heart failure, this is a good ECG for teaching the contribution of rate - atrial and ventricular - in the workload and cardiac output of the patient.</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/58/feed" method="post" id="fivestar-custom-widget--6" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--12" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Atrial Flutter With Variable Conduction 1/5</option><option value="40">Give Atrial Flutter With Variable Conduction 2/5</option><option value="60">Give Atrial Flutter With Variable Conduction 3/5</option><option value="80" selected="selected">Give Atrial Flutter With Variable Conduction 4/5</option><option value="100">Give Atrial Flutter With Variable Conduction 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.9</span></span> <span class="total-votes">(<span >7</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--6" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-QXDW7bmQFkzns5VoUL4UJnpKCBDOT_IXAK76H8j7p8I" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/atrial-flutter-variable-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial flutter with variable conduction</a></div><div class="field-item odd"><a href="/ecg/atrial-flutter-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial flutter</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_6"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fatrial-flutter-variable-conduction-2&amp;title=Atrial%20Flutter%20With%20Variable%20Conduction"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sun, 21 Jun 2015 17:31:57 +0000 Dawn 645 at https://www.ecgguru.com https://www.ecgguru.com/ecg/atrial-flutter-variable-conduction-2#comments Atrial Flutter With Variable Conduction https://www.ecgguru.com/ecg/atrial-flutter-variable-conduction-1 <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/atrial-flutter-variable-conduction-1"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AFL%20100%20Atrial%20flutter%20w%20variable%20cond.jpg" width="1800" height="1485" alt="" /></a></div><div class="field-item odd"><a href="/ecg/atrial-flutter-variable-conduction-1"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AFL%20100%20Atrial%20flutter%20w%20variable%20cond%20beats%20numbered.jpg" width="1800" height="1485" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This ECG provides an example of atrial flutter with variable conduction. &nbsp;There are two distinct R - R intervals, making this a somewhat <strong>regularly-irregular</strong> &nbsp;rhythm, as opposed to the irregular irregularity of atrial fibrillation. &nbsp;The flutter waves (P waves) are very easy to see in most leads, but not in all. &nbsp;If you are teaching students who are making the transition from reading monitors and rhythm strips to 12-lead ECGs, this is a great ECG to illustrate for them how the more leads you have, the more you will see. &nbsp;The flutter waves are invisible in Lead I and, to the untrained eye, they may be hard to see in the precordial leads. &nbsp;The four channels on this ECG are run simultaneously, so if &nbsp;P waves or flutter waves are visible in one lead, they are also present in all leads that line up vertically with that one. &nbsp;In other words, the Lead II rhythm strip at the bottom confirms that flutter waves exist across the entire ECG.</p><p>The R - R intervals in this ECG reflect alternating 2:1 and 4:1 conduction. &nbsp;There are a couple of times when the 4:1 ratio repeats itself without alternating. &nbsp;Often, the length of these varying R - R intervals will be multiples of each other, or have a common denominator. &nbsp;These do not appear to, and may reflect the fact that, when R to P intervals lengthen, R to R intervals sometimes shorten. &nbsp;In other words, the PR intervals, which are difficult to measure in atrial flutter, may be changing. &nbsp;I would invite my colleagues with more expertise in this area to comment below.</p><p>There are no blatant ST segment abnormalities here, but ST segments can be very difficult to assess in atrial flutter because of the flutter waves. &nbsp;We do not have clinical data, other than this is a 62-year-old man.</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/58/feed" method="post" id="fivestar-custom-widget--7" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--14" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Atrial Flutter With Variable Conduction 1/5</option><option value="40">Give Atrial Flutter With Variable Conduction 2/5</option><option value="60">Give Atrial Flutter With Variable Conduction 3/5</option><option value="80" selected="selected">Give Atrial Flutter With Variable Conduction 4/5</option><option value="100">Give Atrial Flutter With Variable Conduction 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.4</span></span> <span class="total-votes">(<span >52</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--7" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-FcfyxXkv0fjof7lQmYJfDvGk0suVPE5k6Va4O-w-n9Y" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/atrial-flutter-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial flutter</a></div><div class="field-item odd"><a href="/ecg/tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Tachycardia</a></div><div class="field-item even"><a href="/ecg/wenckebach-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wenckebach Conduction</a></div><div class="field-item odd"><a href="/ecg/grouped-beating" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Grouped beating</a></div><div class="field-item even"><a href="/ecg/atrial-flutter-ariable-conduction" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial flutter with ariable conduction</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_7"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fatrial-flutter-variable-conduction-1&amp;title=Atrial%20Flutter%20With%20Variable%20Conduction"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Tue, 04 Nov 2014 06:24:57 +0000 Dawn 604 at https://www.ecgguru.com https://www.ecgguru.com/ecg/atrial-flutter-variable-conduction-1#comments ECG Basics: Atrial Flutter With 2:1 Conduction Ratio, Rhythm strip https://www.ecgguru.com/ecg/ecg-basics-atrial-flutter-21-conduction-ratio-rhythm-strip <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/ecg-basics-atrial-flutter-21-conduction-ratio-rhythm-strip"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/132%20A%20Flutter%20with%202%20to1%20conduction%20%20MRAFL100.jpg" width="1800" height="397" alt="" /></a></div><div class="field-item odd"><a href="/ecg/ecg-basics-atrial-flutter-21-conduction-ratio-rhythm-strip"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/132%20with%20markup.jpg" width="1800" height="397" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p><span style="font-family: Verdana, Helvetica, Arial, sans-serif; line-height: 17.727272033691406px;">One of the most frequently misdiagnosed rhythms, atrial flutter with 2:1 conduction often masquerades as sinus tach. &nbsp;Sinus tach usually has an obvious cause, such as exercise, severe hypovolemia, or age less than 6 months. &nbsp;Atrial flutter usually produces flutter waves (P waves) at a rate of 250 - 350 per minute. &nbsp;Therefore, a 2:1 conduction ratio would result in a heart rate of about 125 - 175 bpm). &nbsp;</span></p><p><span style="font-family: Verdana, Helvetica, Arial, sans-serif; line-height: 17.727272033691406px;">Often, students are taught about atrial flutter using an electronic rhythm generator or a book with limited illustrations, and they become acustomed to seeing atrial flutter with 3:1 or 4:1 conduction. &nbsp;The flutter waves are very easy to see in such a situation. &nbsp;However, the AV node, if not affected by medication, is usually well able to conduct at a rate of 150 or more. &nbsp;Therefore, the physiological block that protects us from extreme rates will keep the heart rate around 150 bpm in atrial flutter.</span></p><p><span style="font-family: Verdana, Helvetica, Arial, sans-serif; line-height: 17.727272033691406px;">This is a single rhythm strip. &nbsp;It can be VERY helpful to look at multiple leads to look for flutter waves. &nbsp;See this week's <a title="atrial flutter with 2:1 conduction ratio" href="http://ecgguru.com/ecg/instructors-collection-ecg-week-july-17-2014-atrial-flutter-21-conduction">Instructors' Collection ECG of the WEEK</a> for the SAME patient's 12-Lead ECG. &nbsp;Also, your students should be reminded that sinus rhythms, including sinus tach, tend to change rates based on the needs of the patient. &nbsp;For example, as a patient is treated for his/her condition, the rate may improve by slowing. &nbsp;Conversely, if the condition becomes worse, or the patient is stressed, the rate may increase. &nbsp;Atrial flutter, like all re-entry tachycardias, tends to stay at a steady rate unless the conduction ratio changes.</span></p><p><span style="font-family: Verdana, Helvetica, Arial, sans-serif; line-height: 17.727272033691406px;">Show your students that the flutter waves are CONTINUOUS. &nbsp;That is, they don't pause for the QRS. &nbsp;The second illustration shows the flutter waves highlighted, to aid in seeing the continuous line of flutter waves.</span></p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/58/feed" method="post" id="fivestar-custom-widget--8" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--16" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give ECG Basics: Atrial Flutter With 2:1 Conduction Ratio, Rhythm strip 1/5</option><option value="40" selected="selected">Give ECG Basics: Atrial Flutter With 2:1 Conduction Ratio, Rhythm strip 2/5</option><option value="60">Give ECG Basics: Atrial Flutter With 2:1 Conduction Ratio, Rhythm strip 3/5</option><option value="80">Give ECG Basics: Atrial Flutter With 2:1 Conduction Ratio, Rhythm strip 4/5</option><option value="100">Give ECG Basics: Atrial Flutter With 2:1 Conduction Ratio, Rhythm strip 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >2</span></span> <span class="total-votes">(<span >2</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--8" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-JI-EkLwokaOjYu0oN1LvE_6HYm0rtt_SMDkYtiA421g" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/ecg-basics" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">ECG Basics</a></div><div class="field-item odd"><a href="/ecg/basic-ecg" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Basic ECG</a></div><div class="field-item even"><a href="/ecg/rhythm-strip" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Rhythm strip</a></div><div class="field-item odd"><a href="/ecg/atrial-flutter-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial flutter</a></div><div class="field-item even"><a href="/ecg/atrial-flutter-21-conduction-1" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial flutter with 2:1 conduction</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_8"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fecg-basics-atrial-flutter-21-conduction-ratio-rhythm-strip&amp;title=ECG%20Basics%3A%20%20Atrial%20Flutter%20With%20%202%3A1%20Conduction%20Ratio%2C%20Rhythm%20strip"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Thu, 17 Jul 2014 21:40:30 +0000 Dawn 589 at https://www.ecgguru.com https://www.ecgguru.com/ecg/ecg-basics-atrial-flutter-21-conduction-ratio-rhythm-strip#comments Atrial Flutter With 2:1 Conduction https://www.ecgguru.com/ecg/atrial-flutter-21-conduction-0 <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/atrial-flutter-21-conduction-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/MRAFL101.jpg" width="1800" height="979" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>One of the most frequently misdiagnosed rhythms, atrial flutter with 2:1 conduction often masquerades as sinus tach. &nbsp;Sinus tach usually has an obvious cause, such as exercise, severe hypovolemia, or age less than 6 months. &nbsp;Atrial flutter usually produces flutter waves (P waves) at a rate of 250 - 350 per minute. &nbsp;Therefore, a 2:1 conduction ratio would result in a heart rate of about 125 - 175 bpm). &nbsp;Often, students are taught about atrial flutter using an electronic rhythm generator or a book with limited illustrations, and they become acustomed to seeing atrial flutter with 3:1 or 4:1 conduction. &nbsp;The flutter waves are very easy to see in such a situation. &nbsp;However, the AV node, if not affected by medication, is usually well able to conduct at a rate of 150 or more. &nbsp;Therefore, the physiological block that protects us from extreme rates will keep the heart rate around 150 bpm in atrial flutter.</p><p>This ECG shows two instances where the conduction ratio slows to 3:1 momentarily, at beats no. 3 and 20. &nbsp;This makes the atrial flutter more apparent. &nbsp;Students should be taught to check multiple leads in any patient with a heart rate of between 125 bpm and 175 bpm, and look for flutter waves. &nbsp;Flutter waves are continuous - they do not "pause" for the QRS. &nbsp;For a rhythm strip with the flutter waves highlighted, see this patient's <a title="Atrial flutter with 2:1 conduction marked" href="http://ecgguru.com/ecg/ecg-basics-atrial-flutter-21-conduction-ratio">rhythm strip.</a></p><p>&nbsp;</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/58/feed" method="post" id="fivestar-custom-widget--9" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--18" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Atrial Flutter With 2:1 Conduction 1/5</option><option value="40">Give Atrial Flutter With 2:1 Conduction 2/5</option><option value="60" selected="selected">Give Atrial Flutter With 2:1 Conduction 3/5</option><option value="80">Give Atrial Flutter With 2:1 Conduction 4/5</option><option value="100">Give Atrial Flutter With 2:1 Conduction 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3</span></span> <span class="total-votes">(<span >6</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--9" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-59_7htbpE3Mk93A6lyYjXR_cCKL2myPNLrmPAhRqwK8" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/atrial-flutter-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial flutter</a></div><div class="field-item odd"><a href="/ecg/atrial-flutter-21-conduction-1" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial flutter with 2:1 conduction</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_9"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fatrial-flutter-21-conduction-0&amp;title=Atrial%20Flutter%20With%202%3A1%20Conduction"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Thu, 17 Jul 2014 20:32:39 +0000 Dawn 588 at https://www.ecgguru.com https://www.ecgguru.com/ecg/atrial-flutter-21-conduction-0#comments Atrial Flutter With 2:1 Conduction And Left Bundle Branch Block https://www.ecgguru.com/ecg/atrial-flutter-21-conduction-and-left-bundle-branch-block <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/atrial-flutter-21-conduction-and-left-bundle-branch-block"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/AFLLBB%20100.jpg" width="1800" height="1345" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This ECG is a two-for-one teaching opportunity. &nbsp;This elderly woman presents with a tachycardia at about 120/min. &nbsp;We do not have any other information about her complaints or past medical history.</p><p>Her ECG shows a wide-complex tachycardia. &nbsp;The QRS complexes are about 124 ms (.12 sec.) wide. &nbsp;On the most <strong>basic level</strong>, we should teach our students to consider ALL wide-complex tachycardias to be ventricular tachycardia until proven otherwise. &nbsp;This ECG has many clues that it is NOT ventricular tachycardia. &nbsp;Tiny P waves can be seen in V1, V2, and V3. &nbsp; But, these are not the only P waves. &nbsp;The atrial rate in this case is twice the ventricular rate, making the rhythm ATRIAL FLUTTER with 2:1 conduction. &nbsp;The flutter rate is about 240/minute, slightly on the slow side for AFL. &nbsp;Atrial flutter with 2:1 conduction is often missed, as every other P wave is hidden. &nbsp;Look at aVR and Lead II in this case for signs of the regular flutter waves. &nbsp;It is important to look in all 12 leads for signs of flutter waves in any tachycardia over 120/min. &nbsp;Occasionally, you will get lucky, and the patient will conduct at a different ratio, such as 3:1 or 4:1, making the flutter waves much more visable. &nbsp;Sometimes, the atrial flutter becomes apparent during carotid sinus massage or a Valsalva maneuver.</p><p>The QRS width, in this case, is due to left bundle branch block. &nbsp;The criteria for LBBB are: &nbsp;Wide QRS, Supraventricular Rhythm (in this case, atrial flutter), and a negative QRS in V1 with a positive QRS deflection in Leads I and V6. &nbsp;The ST changes seen here are typical of LBBB: &nbsp;ST depression in leads with upright QRS complexes and ST elevation in leads with downward QRS complexes.</p><p>&nbsp;</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/58/feed" method="post" id="fivestar-custom-widget--10" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--20" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Atrial Flutter With 2:1 Conduction And Left Bundle Branch Block 1/5</option><option value="40">Give Atrial Flutter With 2:1 Conduction And Left Bundle Branch Block 2/5</option><option value="60">Give Atrial Flutter With 2:1 Conduction And Left Bundle Branch Block 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href="/ecg/atrial-flutter-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Atrial flutter</a></div><div class="field-item odd"><a href="/ecg/left-bundle-branch-block-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left bundle branch block</a></div><div class="field-item even"><a href="/ecg/lbbb" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">LBBB</a></div><div class="field-item odd"><a href="/ecg/bundle-branch-block" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Bundle branch block</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_10"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fatrial-flutter-21-conduction-and-left-bundle-branch-block&amp;title=Atrial%20Flutter%20With%202%3A1%20Conduction%20And%20Left%20Bundle%20Branch%20Block"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Mon, 12 May 2014 04:10:19 +0000 Dawn 573 at https://www.ecgguru.com https://www.ecgguru.com/ecg/atrial-flutter-21-conduction-and-left-bundle-branch-block#comments