Features of atrioventricular (AV) conduction, unusual aberrant ventricular conduction, coexisting with atrial fibrillation (AF) result in diverse ECG picture of AFL (6). Is why the diagnostics of atypical AFL requires thorough ECG analysis. In real clinical practice, the pattern of typical AFL occurs only in 70-80% of patients (1, 4), that Which causes the changing F waves polarity (1-3, 5). In 10-30% of typical AFLs, the reentrant circuit rotates in a clockwise direction around the tricuspid valve, For clinicians, a key point of ECG diagnostics of typical AFL is to identify a “saw tooth” flutter curve with characteristic F waves in II, III, aVF and V1 leads, which are caused by AFL waves circulating in the right atrium. Atrial flutter can be described as counterclockwise or clockwise typical (cavotricuspid isthmus (CTI)-dependent) and atypical by ECG (2). Sometimes we need only atrial mapping for precise diagnosis. However, proper interpretation of ECG may be rather difficult in patients with AFL and different types of atrial tachycardias (AT). ![]() It is still the tool of the first choice for practitioners that largely determines further diagnostics and treatment strategy to be used to manage a patient (3, 4). Despite of recent advances in invasive electrophysiology, electrocardiography (ECG) remains one of the most effective methods used for rhythm disorders diagnostics. Atrial flutter (AFL) is one of the most common supraventricular arrhythmias with macro-reentrant mechanism of atrial activation around an anatomical barrier with regular atrial rate ≥ 240 beats/min (1, 2).
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