Clockwise flutter

Patient

54-year-old obese woman; hospitalization for palpitations; recording of the electrocardiogram;

Trace

Irregular ventricular rhythm; evidence of rapid, regular and monomorphic atrial activity of 220 bpm; the morphology does not correspond to that of a counterclockwise common flutter; the atrial depolarization wave is positive, wide in the inferior leads with a visible notch in leads II, III but also in aVR; the atrial activity is negative in V1 and positive in V6; it is therefore a clockwise atrial flutter of the right atrium;

Exergue

10% of patients with common flutter episodes also have clockwise flutter episodes, the right atrial reentry circuit being the same but rotating in the opposite direction (clockwise). It is therefore necessary to know their electrocardiographic characteristics and to make the differential diagnosis with that of a left flutter.