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Does a flutter have p waves1/22/2024 ![]() ![]() 1 This circuit will continue until it is terminated by another PAC or with medical intervention (eg, vagal maneuvers, etc.). By the time the impulse reaches the His-bundle, the fast pathway is no longer refractory, and this allows the impulse to simultaneously conduct anterograde to the ventricles and retrograde to the atria via the fast pathway. 1 It is triggered by a PAC that conducts down the slow pathway of the AV node while the fast pathway is still refractory from the previous impulse. It is a common cause of paroxysmal SVT that is typically seen in young patients with no structural heart disease. Conduction down the AP and back up the AV node is called antidromic conduction and will result in a WCT that mimics VT.ĪVNRT is a reentry tachycardia that involves two pathways in or around the AV node. Conduction down the AV node and back up the AP is called orthodromic conduction and will result in a NCT that mimics AVNRT. 1ĪVRT is reentry tachycardia that involves the AV node and an accessory pathway (eg, the Bundle of Kent in patients with WPW). Note that the classic saw-tooth pattern is not always obvious with 2:1 conduction. 1 Flutter waves typically have a fixed rate of 250-350 bpm with a uniform morphology and are best seen in leads II and V1. Junctional tachycardia, which is associated with ventricular rates of 90-140 bpm, is unlikely given the rate of 196 bpm seen in this EKG.Ītrial flutter with 2:1 conduction should be considered in any regular NCT with ventricular rates between 125-175 bpm. Atrial tachycardia, which originates from a single ectopic focus in the atrium and is associated with structural heart disease, 1 produces P-waves that are morphologically different compared to sinus rhythm. The difference between these two is the morphology of the P-waves. The absence of discernible P-waves rules out sinus tachycardia and atrial tachycardia. AV Reentry Tachycardia (AVRT) with orthodromic conduction.The differential for a regular narrow-complex tachycardia includes: This ECG shows a regular narrow-complex tachycardia with a ventricular rate of 190 bpm, right axis deviation, STE in leads I and aVL, and STD in II, III, aVF, and V2-V6. A 46-year-old male with a history of hypertension presents with palpitations and lightheadedness. ![]()
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