The sawtooth appearance is best seen in the inferior leads and is caused by the circuit alternately heading towards the inferior leads and away as it speeds around the atrium.However, flutter should be suspected in ANY regular tachycardia at or around 150bpm. ATYPICAL flutter can be clockwise in the right atrium, in the left atrium or around sites of previous surgery and can be difficult to identify as they lack the typical sawtooth appearance.TYPICAL atrial flutter runs anti-clockwise around the right atrium and across the cavotricuspid valve isthmus.This means there is a single large re-entry circuit around the atrium which stimulates the AV node every time it passes. ![]() Well known for its sawtooth baseline (see below), atrial flutter is a MACRO-RE-ENTRANT tachycardia.These account for more than 75% of all tachyarrhythmias, both atrial and ventricular. Atrial tachycardias can usually be rate controlled with beta-blockers or calcium channel blockers.APPROPRIATE sinus tachycardia (due to concurrent sepsis/anaemia/thyrotoxicosis/pain) should be left alone and the underlying trigger treated.INAPPROPRIATE sinus tachycardia can be slowed using beta-blockers or ivabradine (selective sinus node blocker), however it is usually best left alone.P waves are often hidden in the QRS complex. ![]()
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