Weinberg et al evaluated the impact of criteria on the accuracy of making a diagnosis of atrial flutter. The goal is to avoid the misdiagnosis of atrial fibrillation as atrial flutter (false positive). The authors are from Northwestern University in Chicago.

Patient selection: suspected atrial flutter


Reason for careful distinction of atrial flutter and atrial fibrillation: therapy selection


Criteria for the diagnosis of atrial flutter - both of the following:

(1) constant Flutter (F) waves in the frontal plane

(2) some evidence of a regular ventricular response


F waves:

(1) can show minor variation in morphology

(2) should be relatively uniform in morphology and rate within a lead

(3) do not have to look like "sawtooth" waves


Regular ventricular response may involve one of the following:

(1) every RR interval is the same (completely regular)

(2) most of the RR intervals are regular except for a few beats

(3) varying conduction ratios ("regularly irregular", in contrast to the "irregularly irregular" of atrial fibrillation)


Some minor variation in RR intervals can be seen. This may be easily seen at slower heart rates.

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