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Atrial Flutter with 3:1 block

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  • Regular rhythm in presence of fixed AV block.
  • Ventricular rate ~150 bpm in presence of 2:1 AV block.
  • Flutter waves / ‘saw-tooth pattern’ best seen in leads II, III, aVF and V1.
  • Flutter wave morphology depending on type of atrial flutter (see above).
  • QRS complexes usually  < 120 ms unless pre-existing bundle branch block, accessory pathway, or rate related aberrant conduction.
  • Variable AV block will result in an irregular rhythm.
  • Absence of an isoelectric baseline.

Atrial flutter with a 3:1 block
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