ECG Case 249 Interpretation

This post is an answer to the ECG Case 249

  • Rate:
    • Ventricular rate ~136 bpm
    • Atrial rate ~ 270 bpm
  • Rhythm:
    • Regular atrial & ventricular activity
    • Atrial activity best seen in leads I & V1 
    • Notching in terminal portion of QRS and also in isoelectric segment
Atrial activity highlighted in leads I & V1
Atrial activity highlighted in leads I & V1

  • Axis: LAD
  • Intervals:
    • QRS – Prolonged (140ms)
    • QT – 310ms
  • Segments:
    • Appropriate ST segment & T wave discordance
    • Sgarbossa Negative
  • Additional:
    • Typical LBBB Morphology

Interpretation

  • Regular Wide Complex Tachycardia
  • Evidence of 2:1 conduction
  • Likely Atrial Flutter or atrial tachycardia
  • LBBB Morphology
  • DDx – Native, rate related or aberrancy
Atrial activity in leads I & V1, likely Atrial Flutter with 2:1 conduction
Atrial activity in leads I & V1, likely Atrial Flutter with 2:1 conduction

READ MORE: Atrial Flutter: ECG Interpretation [With Examples]

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