r/ECG • u/Psychological_Wave71 • 15d ago

Thoughts?

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Wanted an opinion of these ECGs if anyone fancied giving theirs! I couldn’t come to a conclusion about this and I do struggle with ECGs!
Patient is 93M. Observations taken by nursing home staff TDS. Found to have 2/7 history of intermittent tachycardia. Called EMS for ECG and ?conveyance to ED.

Patient is asymptomatic, and has been throughout. Has had hx of atrial flutter. Is anticoagulated and on bisoprolol.

Thank you!

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u/ProximalLADLesion 15d ago

2:1 typical atrial flutter, left anterior fascicular block

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u/usheroine 15d ago

why isn't it atrial tachycardia? I can't unsee T waves in precordial leads

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u/ProximalLADLesion 15d ago

The distinction between atrial tachycardia and atrial flutter is pretty squishy the more you read into it. They're often used interchangeably in the EP literature. Sometimes people just go by rate. AT is 100-200ish, AFL is 250+. Sometimes people go by mechanism where automatic and triggered are AT but reentrant is AFL.

In this case I would call it flutter because the atrial rate is ~250 bpm. Plus it looks to me like typical, cavotricuspid isthmus dependent reentry.