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Type I atrial flutter, counterclockwise rotation with 3:1 and 4:1 AV nodal block. Atrial flutter with a two to one block. Note the P waves hiding in the T waves in leads V1 and V2. Type I atrial flutter, also known as common atrial flutter or typical atrial flutter, has an atrial rate of 240 to 340 beats/minute.
Electrode placement for Lewis lead; RL electrode (green), not shown, remains on leg . A Lewis Lead (also called the S5 lead) is a modified ECG lead used to detect atrial flutter waves when atrial flutter is suspected clinically, based on signs and symptoms, but is not definitely demonstrated on the standard 12 lead ECG.
Atrial flutter is used to describe when the atria contract at really high rates—about 300 beats per minute, but sometimes as high as 400 beats per minute. Why flutter? Well there’s a wave of muscle contraction that flows through the atria that looks like its flapping or fluttering, hence the name.
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A wandering atrial pacemaker can be either normal or irregular in rate, much like a sinus arrhythmia the rate is normally between 60 - 100 bpm when it is normal and less than 60 when it is slow, the distinguishing feature of this rhythm is a p wave that varies in size, shape, and direction, the PR interval can either be normal or irregular ...
This is the property of the AV node that prevents rapid conduction to the ventricle in cases of rapid atrial rhythms, such as atrial fibrillation or atrial flutter. The AV node's normal intrinsic firing rate without stimulation (such as that from the SA node) is 40–60 times/minute. [13]
The presentation and symptoms a patient can present with are varied and often dependent on the underlying cause of the junctional rhythm. Patient's can be asymptomatic for example, or experience difficulty breathing and chest pain if they have underlying congestive heart failure.
The ECG will show a terminal R wave in lead V1 and a slurred S wave in lead I. Left bundle branch block widens the entire QRS, and in most cases shifts the heart's electrical axis to the left. The ECG will show a QS or rS complex in lead V1 and a monophasic R wave in lead I.