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Atrial Flutter example four



This unusual example of atrial flutter was obtained during a code situation.  The baseline is unlike most atrial flutter: there is no sawtooth appearance.  The F-F interval is 0.29 seconds, giving an atrial rate of 206, an unusually slow rate, probably due to a medication effect or to atrial disease.  The R-R interval is 1.16 seconds, with a ventricular rate of 51.  The capture ratio is thus four to one.  Note the flutter waves partially concealed in the tails of the T-waves.  If the F-waves are marched out, it becomes clear that another F-wave is buried in the QRS complexes.  Also note the marked ST elevation in leads II, III, and AVF:  this patient is having an inferior MI.