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Requests for reprints should be addressed to David S. Frankel, MD, Cardiovascular Division, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St., 9 Founders Pavilion, Philadelphia, PA 19104.
A man in his 70s with past medical history of hypertension and coronary artery disease
presented to the Emergency Department with palpitations, fatigue, and dyspnea on exertion.
On physical examination, he was alert and in mild distress. His heart rate was 97
beats per minute and blood pressure was 162/79 mm Hg. Cardiovascular examination was
notable for irregularly irregular rhythm. The 12-lead electrocardiogram (ECG) is shown
in the Figure, panel A.
Figure(A) Presenting 12-lead electrocardiogram. The electrocardiogram (ECG) shows chaotic atrial
activity, irregular ventricular response and occasional premature ventricular complexes.
(B) Twelve-lead ECG of typical atrial flutter. Multiple ECG leads demonstrate flutter
waves of consistent morphology, amplitude, and cycle length.
Prevalence and electrophysiological characteristics of typical atrial flutter in patients with atrial fibrillation and chronic obstructive pulmonary disease.
