Blog

This post is an answer to the ECG Case 224

• Rate:
  • Ventricular rate ~145 bpm
  • Atrial rate ~290 bpm
• Rhythm:
  • Regular
  • Flutter waves, best visualised in lead V1 (image below)

• Axis: LAD
• Intervals: 
  • QRS – Prolonged (140ms)
  • QT – 320ms
• Segments:
  • Discordant ST elevation leads II, aVF, V1-5
  • Discordant ST depression leads I, aVL, V6
• Additional:
  • Typical LBBB morphology
  • T wave inversion in leads I, aVL
  • Positive F wave in lead V1
  • Negative F waves in aVF

Interpretation

In this ECG the morphology of the conduction delay is typical of left bundle branch block (this could be pre-existing or rate related, need a sinus ECG to compare) without any features suggestive of VT with LBBB.

Also examination of lead V1 shows flutter waves at a rate of ~290 bpm, so the rhythm is Atrial Flutter with 2:1 conduction.

READ MORE:

• Atrial Flutter – ECG Interpretation [With Examples]
• Never Mistake Ventricular Tachycardia for Supraventricular Tachycardia with Aberrant Conduction

SIMILAR CASES:

• ECG Case 180: Atrial flutter with 2:1 AV conduction
• ECG Case 140: Atrial flutter with 2:1 conduction