{"id":10873,"date":"2026-06-29T06:18:40","date_gmt":"2026-06-29T06:18:40","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10873"},"modified":"2026-07-02T11:36:59","modified_gmt":"2026-07-02T11:36:59","slug":"trace-6-6-atypical-flutter","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-6-6-atypical-flutter\/","title":{"rendered":"Trace 6.6: Atypical flutter"},"content":{"rendered":"","protected":false},"featured_media":9736,"template":"","ecg_case_type":[255],"language_ecgcase":[258],"class_list":["post-10873","ecg_case","type-ecg_case","status-publish","has-post-thumbnail","hentry","ecg_case_type-atrial-fibrillation-atrial-flutter-atrial-tachycardia","language_ecgcase-english"],"acf":{"ecg_case_title":"Trace 6.6: Atypical flutter","patient_description":"78-year-old man with a history of pulmonary embolism and chronic cor pulmonale; hospitalization for palpitations (rate of 130 bpm); recording of the electrocardiogram at the time of performing a sino-carotid massage;","quiz_question":"Which answer(s) is(are) true regarding the diagnosis(es) on this ECG?","quiz_answer_1":"left bundle branch block","quiz_answer_2":"right bundle branch block + left anterior fascicular block","quiz_answer_3":"right bundle branch block + left posterior fascicular block","quiz_answer_4":"ventricular tachycardia","quiz_answer_5":"atrial flutter","correct_answer":["B","E"],"ecg_image":9736,"ecg_description":"Tachycardia at 130 bpm with wide QRS, right delay, left axis; carotid massage slows the nodal conduction and allows demonstrating a fast, regular and monomorphic atrial activity of 260 bpm; the morphology does not correspond to that of a counterclockwise common flutter; the atrial depolarization wave is positive and broad in the inferior leads with a visible notch in leads II, III but also in aVR; atrial activity is negative in V1 and positive in V6; it is therefore an atrial clockwise flutter of the right atrium with an initial 2:1 conduction with a right bundle branch block and a left anterior fascicular block;","ecg_info_box":"The clockwise right atrial flutter pattern includes: 1) an atrial rate usually between 250 and 300 bpm, 2) a positive atrial activation with a notch in the inferior leads, 3) a weak voltage pattern in aVL, 4) a positive component in V6 and negative component in V1.","commentary_ecg":"10% of patients with common flutter episodes also experience clockwise flutter episodes, the right atrial reentry circuit being the same but rotating in the other direction (clockwise). The anatomical and functional constraints are identical to the common flutter although the activation is reversed, cranio-caudal in the septum, caudo-cephalic in the anterior wall. While the incidence of this type of flutter is relatively low, it can be induced by pacing in the electrophysiology room in 50% of patients with a common flutter.\r\n\r\nOn the electrocardiogram, we find a monomorphic and rapid pattern (tachycardia cycle identical to that of the common flutter) of atrial activity. Some characteristic elements allow establishing the diagnosis:\r\n\r\n\u2022 In the inferior leads II, III, aVF: a predominantly positive, wide wave with a notch in the positive portion in lead II (positive flutter pattern inferiorly) is frequently found; the pattern can be less characteristic with negative atrial activity recalling the pattern of the common flutter\r\n\u2022 The atrial depolarization wave is often negative, of low amplitude, with a notch in aVL\r\n\u2022 Lead V1 also often displays a characteristic pattern, with a wide negative bifid activation; a notch can also be evidenced in the middle of the negative deflection of the flutter wave\r\n\u2022 There is a transition in the precordium between the negative activity in V1 and the positive activity in V6.\r\n","ecg_info_post_answer":"<img class=\"alignnone wp-image-10884 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/06\/trace-6-6-ecg-en-1024x576.jpg\" alt=\"\" width=\"800\" height=\"450\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trace 6.6: Atypical flutter - Cardiocases<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-6-6-atypical-flutter\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trace 6.6: Atypical flutter - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-6-6-atypical-flutter\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-07-02T11:36:59+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-6-6-ecg-e1782933607962.jpeg\" \/>\n\t<meta property=\"og:image:width\" content=\"1747\" \/>\n\t<meta property=\"og:image:height\" content=\"1040\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data1\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-6-6-atypical-flutter\\\/\",\"url\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-6-6-atypical-flutter\\\/\",\"name\":\"Trace 6.6: Atypical flutter - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/cardiocases.com\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-6-6-atypical-flutter\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-6-6-atypical-flutter\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/cardiocases.com\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/trace-6-6-ecg-e1782933607962.jpeg\",\"datePublished\":\"2026-06-29T06:18:40+00:00\",\"dateModified\":\"2026-07-02T11:36:59+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-6-6-atypical-flutter\\\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-6-6-atypical-flutter\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-6-6-atypical-flutter\\\/#primaryimage\",\"url\":\"https:\\\/\\\/cardiocases.com\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/trace-6-6-ecg-e1782933607962.jpeg\",\"contentUrl\":\"https:\\\/\\\/cardiocases.com\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/trace-6-6-ecg-e1782933607962.jpeg\",\"width\":1747,\"height\":1040},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/cardiocases.com\\\/ecg_case\\\/trace-6-6-atypical-flutter\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/cardiocases.com\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trace 6.6: Atypical flutter\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/cardiocases.com\\\/#website\",\"url\":\"https:\\\/\\\/cardiocases.com\\\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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