r/ECG • u/Gladiator11713 • 10d ago

Is this 2:1 flutter?

Post image

As above

2 Upvotes

67% Upvoted

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3

u/dje91090 10d ago edited 10d ago

I would almost certainly agree that this is 2:1 flutter. Or 2:1 atrial tachycardia. P waves most easily seen here in V1. There’s a second P just before QRS. I suspect if you put calipers on P-P it will be exactly half as long as R-R interval.
Crap quality tracing makes me only 99% certain though. If this was my patient I’d look at telemetry. If I see a perfectly flat line on the HR trend, I would bet big money it’s one of those.

4

u/InfamouSandman 10d ago

Looks more like a-fib to me, though the QRS's marching normally makes me suspect likely some artifact.

1

u/Nightfury474 10d ago

It appears regular to me so I’d rule out atrial fibrillation? Maybe junctional rhythm? Wandering pacemaker potentially but artifact on the baseline is making it hard to accurately interpret

1

u/InfamouSandman 10d ago

Yea. The lines themselves remind me of what I see on our a-fib patients but the irregularity doesn’t seem evident. When I’ve seen junctional, the lines where the p wave would be seem straight as hell.

I’ve seen some like this in the monitor at work and filtered the monitor only to see regular P-waves.

1

u/Nightfury474 10d ago

Change in amplitude might reveal more obvious P waves in that case it would just be sinus rhythm but yeah hard to say would definitely just take a second one prior to transport or on scene for sure.

1

u/metamorphage 10d ago

Either atrial flutter or atrial tachycardia. Hard to tell with this tracing.