Atrial flutter with 2:1 conduction
A Fast Pulse for Several Weeks
A woman in her sixties with lupus and antiphospholipid syndrome has a persistently fast pulse at follow-up.
Look for
- Regular repetitive atrial activity: flutter waves.
- Continuous undulations between QRS complexes.
- Two atrial activations per QRS according to the source.
Where to look. Compare II, III, aVF, and V1; look for flutter waves hidden within T waves or QRS complexes.
A reentry circuit rapidly activates the atria. Only some impulses reach the ventricles, so the ventricular rate can be much slower.
Inferior flutter waves are positive in this clockwise flutter: negative polarity is not required.
References & provenance
The ECG Made Easy, 9e, ch. 4, PDF 105–107; Lilly, 6e, ch. 12, p. 295–296.
A Case of Chronic Undiagnosed 2:1 Isolated Atrial Flutter in a Patient With an Autoimmune Disease
Tegan Clarke; Eric Leung; Anthony Fleg; Alexander Muacevic; John R Adler. A Case of Chronic Undiagnosed 2:1 Isolated Atrial Flutter in a Patient With an Autoimmune Disease. 2023. doi:10.7759/cureus.48240. Figure 1. CC BY 4.0. CC BY 4.0
Adaptation: cropping and removal of headers/annotations outside the tracing where applicable; metadata removed. Waveforms have not been redrawn.
Compared with the published source; no independent clinical validation is claimed.
Original annotations & limitations
Flutter auriculaire avec conduction 2:1
Femme dans la soixantaine; antécédents de lupus et syndrome antiphospholipide; rythme rapide persistant au suivi; ondes F positives dans les dérivations inférieures.
Flutter typique horaire: ne pas enseigner que toutes les ondes F sont négatives en II/III/aVF.