ECG: A Case of Flutter-Fibrillation

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ECG: A Case of Flutter-Fibrillation

  1. 1. ECG OF THE WEEK. PROF .DR.P.VIJAYARAGHAVAN’S UNIT. DR.A.KARTHICK RAMALINGAM.
  2. 2. Clinical summary. <ul><li>70 year old Mrs. Devasundari was admitted with </li></ul><ul><li>C/o Chest pain, </li></ul><ul><li>Palpitation, </li></ul>
  3. 5. ECG FINDINGS <ul><li>Atrial rate 340/min </li></ul><ul><li>Ventricular Rate 60/ min. </li></ul><ul><li>Axis +60. </li></ul><ul><li>P waves having morphology intermediate between that of flutter and fibrillation waves. </li></ul>
  4. 6. <ul><li>Rhythm strip shows flutter/fibrillation waves </li></ul><ul><li>No ST , T wave abnormalities seen . </li></ul><ul><li>IMP: </li></ul><ul><ul><li>Flutter - fibrillation </li></ul></ul><ul><ul><li>Atrial flutter is of type I . (Flutter waves are of uniform morphology) </li></ul></ul><ul><ul><li>Clockwise conduction. (Positive F wave II,III,aVF). </li></ul></ul>
  5. 7. Atrial flutter <ul><li>It’s a supraventricular tachycardia caused by reentrant rhthym either in left or right atrium. </li></ul><ul><li>Atrial rate will be around 240 to 400/ min. </li></ul><ul><li>Two types: </li></ul><ul><li>Type 1 or classic form is more common. Involves a single reentrant circuit . </li></ul><ul><li>Type II (atypical) Atypical atrial flutters . Has a rate faster than type I </li></ul>
  6. 8. TYPE I FLUTTER
  7. 9. TYPE I FLUTTER
  8. 10. Anticlockwise and Clockwise
  9. 11. OTHER REENTRANT CIRCUITS
  10. 12. Treatment <ul><li>General goals for the treatment of symptomatic atrial flutter are similar to those for atrial fibrillation and include the following: </li></ul><ul><li>Control of the ventricular rate </li></ul><ul><li>Restoration of sinus rhythm </li></ul><ul><li>Prevention of recurrent episodes, or decrease in their frequency or duration </li></ul><ul><li>Prevention of thromboembolic complications </li></ul><ul><li>Minimization of adverse effects from therapy </li></ul>
  11. 13. TYPE I FLUTTER <ul><li>If pt is clinically stable : consider ventricular rate control and elective ablative therapy of the circuit. </li></ul><ul><li>If pt is hemodynamically compromised : cardioversion immediately or after anticoagulation depending on duration of A. flutter followed by elective abalative therapy. ELECTRICAL CARDIOVERSION IS PREFFERED </li></ul><ul><li>Post ablation pt may or maynot nead antiarrythymics depending on effectiveness of ablation. </li></ul>
  12. 14. TYPE II FLUTTER <ul><li>Ablation can be done in higher centers with facilities to map the circuit . </li></ul>
  13. 15. CATHETER ABLATION
  14. 16. THANK YOU

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