Cardinal flutter device8/17/2023 ![]() ![]() Reverse typical flutter should not be confused with atypical flutter where typical saw tooth waves are uncommon.The later group is termed as atypical atrial flutter that arises from various other focus including left atrium. Still, the surface ECG always help us understand the basic circuits of flutter. It may not be important for those hifi EP guys who can ablate complex arrhythmia with intra cardiac GPS catheters and accurate electro anatomic mapping system. Why should we bother about direction of flutter waves ? * Note: In lead the polarity of F waves in V1 it will be opposite of that of inferior leads. In Reverse typical flutter the flutter waves are upright (with a shallow slope ) in inferior leads but still uses the cavo- tricuspid Isthmus Another study found that short-term use of a Flutter device can reduce airways resistance even in patients with COPD with minimal sputum production. The return circuit is relatively fast, crossing the antero -lateral free wall right atrium and hence the later half saw tooth has a sharp deflection ) ![]() This is because, the forward limb traverses the slow path of the circuit namely the cavo-tricuspid Isthmus, it then ascends up in the inter atrial septum (There by inscribing inverted F waves in leads 2,3,aVF. The general rule is the shallow stroke (one with a lesser slope) is to be termed as antegrade / initial deflection that will determine the direction of flutter waves. Ie Is the flutter waves are inverted or upright ? Though this saw tooth pattern is easily recognised, it’s often difficult to say whether the saw is facing upwards or downwards ? We know, classical Atrial flutter (Also referred to as typical /Common AF) records saw toothed F waves due to continuous atrial electrical activity across a macro- reentrant circuit within right atrium. ![]()
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