Embedded Files
Atrial flutter with fixed 2:1 atrial to ventricular conduction causes a narrow complex regular tachycardia (~ 150 bpm). It is easy to miss and commonly mistaken for sinus tachycardia.
Most commonly missed atrial tachycardia
Always consider when rate is 150 ± 20 bpm
2 atrial beats for every QRS, saw tooth pattern
Flipping the ECG upside down and paying attention to all 12 leads will help you identify subtle flutter waves
The Bix rule, described by cardiologist Harold Bix, states that if a P-wave is located halfway between two QRS complexes, there is a good chance that P-waves are also buried inside the QRS complexes, think flutter!
Reference:
Nikolić G. The Bix rule. Heart Lung 2008;37(4):321–2. PMID: 18620109
Page updated
Google Sites
Report abuse