1. This is not atrial flutter, as the baseline is isoelectric. Due to the macro-reentry mechanism of atrial flutter, a new F-wave begins where the previous one ends. Hence the saw-tooth pattern. Also, if this was flutter, there would not be electrical alternans as here (different height of the QRS complexes). The PR interval is also highly varying, so if those waves are F(flutter) waves, then there must be AV dissociation here..

    If anything, this could be a multifocal atrial tachycardia with 4:1 and 5:1 AV block, but if those rapid, peaky little complexes should be P waves, there must be a a great atrial abnormality underlying here. They are too freakish just to be ectopic.

    I’m also thinking some kind of parasystolia, but I’m not gonna go into that..

    Most of all I’d like to think that this is electrical artifact.

    Anyway, I’d love to know the answer. Any info on the patient? Did you do any new EKGs after this one? With a strip like this, I’d obtain a 12 lead immediately!

    I’d love to post this strip for discussion in the EKG Club by the way.. that could turn out interesting..


  2. If Aflutter, this is a display of a very unusual saw-tooth pattern. I agree that it looks like flutter, but why is the baseline isoelectric between each F-wave? Due to the mechanism of atrial flutter, a new flutter wave would begin where the preceding one ends. Everything else is not logic. This is the hallmark of flutter, and it is not present here.


  3. Wow, I just looked at my comment again, and realized that I’m an idiot. In one breath I say atrial flutter (which I guess is not correct based on PQRST’s logical explanation) and then in the next breath I talk about t-waves.

    Time to go back to school.


  4. Without a 12 lead I would have to vote for artifact or multifocal atrial tachycardia with varied AV conduction.

    I’d love to know the outcome on this one. Please let us know!


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