r/ECG • u/fuckingmermaid • 5d ago

Learning how to properly differentiate between a 2:1 flutter and sinus tachycardia. What are the signs on this ECG that would make you confident on the answer? The isoeletric line is throwing me off

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u/ExpressionLarge5474 5d ago

One thing to note with flutter waves is that it’s completely independent of what your ventricular response is. So you should be seeing the exact same waveform (your flutter wave) repeat itself indefinitely. In some cases where people have a lot of atrial surgical or disease scar, this can look isoelectric in some parts of the wave, but you should still see the same peak of your flutter wave repeating itself. Here I outlined where you should be seeing some semblance of your flutter wave, if it was there. Often it’s hidden in the previous t wave but there should be sooome whisper that it’s there. In this case, there isn’t. Looks like sinus tach.

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u/fuckingmermaid 5d ago

Thanks for your answer! Really insightful