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Patient
78-year-old man treated with flecainide and beta-blocker for episodes of paroxysmal AF; consultation for palpitations and asthenia experienced since several days;
Trace
On this tracing, we find a typical pattern of common flutter (counterclockwise circuit in the right atrium, isthmus-dependent); the atrial activity is rapid (270 pm), regular and monomorphic; the inferior leads exhibit the typical sawtooth pattern: negative deflection is predominant, the ascending slope is more abrupt than the descending phase without ever returning to the isoelectric line; atrial activity is very low in lead I, positive in V1 and negative in V6.
Atrioventricular conduction is mainly of the 4:1 type with a ventricular rate close to 75 bpm; the QRS complexes are narrow;
Exergue
The common flutter pattern includes: 1) an atrial rate typically between 250 and 300 bpm, 2) a characteristic sawtooth pattern in the inferior leads, 3) a low amplitude pattern in lead I, 4) a positive component in V1 and a negative component in V6.
The common atrial flutter corresponds to a tachycardia associated with a macro-reentry of the right atrium.