The ECG Diagnosis of Atrial Fibrillation and Atrial Flutter
Atrial fibrillation and atrial flutter are frequently misdiagnosed in clinical practice. This course will augment your ability to diagnose both of these common conditions. You will learn the importance of clinical context and consideration of underlying pathogenic mechanisms in reliably diagnosing both of these related conditions on the ECG.
2.0 x AMA PRA Category 1 Credits™
Available on the Pro Plan
Overview
This course will augment your ability to accurately diagnose atrial fibrillation and atrial flutter on the ECG. We explain how the underlying pathogenic mechanisms generating these arrhythmias result in predictable findings on the ECG. We discuss the importance of the detection of irregularity of rhythm in the diagnosis of atrial fibrillation. We explain the mechanism of decremental conduction by the AV node and teach you how to identify evidence of decremental conduction on the ECG in cases of atrial flutter. We illustrate the limitations of the computer interpretation (CI) reported on many ECG readouts in the diagnosis of these arrhythmias. We teach you the importance of overall clinical context and a high index of suspicion in diagnosing atrial flutter. We show you examples of conditions capable of mimicking atrial fibrillation on the ECG. In case studies, we show you how an experienced generalist approaches the ECG diagnosis of atrial fibrillation and atrial flutter.
Faculty
Planner and Author: Dr John Seery MB PhD
- Consultant Physician at St. Vincent's University Hospital, Dublin, Ireland
- Lecturer at the School of Medicine and Medical Science, University College Dublin, Ireland
- Studied medicine at the University of Cambridge, United Kingdom
- A Natural Sciences graduate of Trinity College Dublin, Ireland
- PhD in Cell Biology from University College London, United Kingdom
Planner: Dr Karen Strahan PhD (University of Cambridge), Head of Editorial
Planner: Tommy O'Sullivan, CME Manager
Estimated Time to Complete
2.0 hours
Target Audience
- Physicians
- Nurses
- Nurse Practitioners
- Physician Assistants
- Paramedics
Learning Objectives
Upon successful completion of this activity, you will be able to:
- Describe the pathogenesis of atrial flutter and atrial fibrillation and explain how this relates to expected ECG findings
- Recognize the pitfalls commonly encountered in the diagnosis of atrial flutter
- Explain the limitations of the computer interpretation in the diagnosis of atrial flutter and atrial fibrillation
- Explain the mechanism of decremental conduction by the AV node
- Appropriately identify and differentiate atrial fibrillation and atrial flutter on the ECG
- Utilize analysis of the overall clinical context in the ECG diagnosis of atrial flutter
- Utilize determination of regularity and irregularity of rhythm in the ECG diagnosis of tachycardia
- Identify conditions capable of mimicking atrial fibrillation on the ECG, reducing the chance of misdiagnosis.
Course Content
- Introduction
- Frontal Heart Schematic
- Atrial Fibrillation: The Mechanism of Chaos
- Atrial Fibrillation: ECG Findings
- What is Atrial Flutter?
- Atrial Flutter: Mechanism
- The AV Node: Decremental Conduction
- Atrial Flutter and Decremental Conduction
- Atrial Flutter: ECG Findings
- Atrial Flutter: An Illustrative Case
- Atrial Fibrillation and Flutter: Clinical Approach
- Quiz
- Quiz Explanation
Release date
28-MAY-2019
Expiration date
27-MAY-2022
Instructions for Participation
Participants must complete the online activity during the valid period as noted above.
Follow these steps:
- View videos in sequence
- Complete the quiz
- View post quiz video to support learning outcomes and objectives
- Complete the activity evaluation form to provide feedback for continuing education purposes and for the development of future activities
- Download the Certificate of Completion
Relevant Financial Disclosures
Planners and faculty for this activity have no relevant financial relationships with commercial interests to disclose.
Bibliography
Iwasaki Y et al. Atrial fibrillation pathophysiology: implications for management. Circulation 2011;124:2264-74.
https://www.ahajournals.org/doi/epub/10.1161/CIRCULATIONAHA.111.019893
Garcia TB and Garcia DJ. Arrhythmia recognition: the art of interpretation. 2nd edition. Jones and Bartlett learning, 5 Wall Street, Burlington, MA.
Kadish AH et al. ACC/AHA Clinical Competence Statement on Electrocardiography and Ambulatory Electrocardiography. Circulation 2001;104(25):3169-78.
https://pubmed.ncbi.nlm.nih.gov/11748119/
Khan R. Identifying and understanding the role of pulmonary vein activity in atrial fibrillation. Cardiovasc Res. 2004;64(3):387-94.
https://academic.oup.com/cardiovascres/article/64/3/387/324239
Lindow T et al. Erroneous computer-based interpretations of atrial fibrillation and atrial flutter in a Swedish primary health care setting. Scand J Prim Health Care. 2019;37(4):426-33. https://www.tandfonline.com/doi/full/10.1080/02813432.2019.1684429
Bui QA et al. Why do Computer Programs Misdiagnose Flutter? Am J Med. 2016;129(11):e289-e290
https://www.amjmed.com/article/S0002-9343(16)30725-2/pdf
Cosío FG. Atrial Flutter, Typical and Atypical: A Review. Arrhythm Electrophysiol Rev. 2017;6(2):55-62.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5522718/
Additional Reading
Bui QA et al. Why do Computer Programs Misdiagnose Flutter? Am J Med. 2016;129(11):e289-e290
https://www.amjmed.com/article/S0002-9343(16)30725-2/pdf
Seery JP and Ryan J. Why does atrial flutter fool us so often? Top ten tips to minimise uncertainty. https://acadoodle.com/articles/19
Seery JP and Ryan J. How to diagnose atrial fibrillation-top 5 tips.
https://www.acadoodle.com/articles/how-to-diagnose-atrial-fibrillation-top-5-tips
ACCME Accreditation Statement
Acadoodle, Ltd is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit Designation Statement
AMA Physician’s Recognition Award
Acadoodle, Ltd designates this enduring material activity for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Activity Title
The ECG Diagnosis of Atrial Fibrillation and Atrial Flutter
Activity Overview
This course will improve your ability to accurately diagnose atrial fibrillation and atrial flutter on the ECG. We explain how the underlying pathogenic mechanisms generating these arrhythmias result in predictable findings on the ECG. We discuss the importance of the detection of irregularity of rhythm in the diagnosis of atrial fibrillation. We explain the mechanism of decremental conduction by the AV node and teach you how to identify evidence of decremental conduction on the ECG in cases of atrial flutter. We illustrate the limitations of the computer interpretation (CI) reported on many ECG readouts in the diagnosis of these arrhythmias. We teach you the importance of overall clinical context and a high index of suspicion in diagnosing atrial flutter. We show you examples of conditions capable of mimicking atrial fibrillation on the ECG. In case studies, we show you how an experienced generalist approaches the ECG diagnosis of atrial fibrillation and atrial flutter.
Faculty
Planner and Author: Dr. John Seery, MB, PhD
- Consultant Physician at St. Vincent's University Hospital, Dublin, Ireland
- Lecturer at the School of Medicine and Medical Science, University College Dublin, Ireland
- Studied medicine at the University of Cambridge, United Kingdom
- A natural sciences graduate of Trinity College Dublin, Ireland
- PhD in Cell Biology from University College London, United Kingdom
Planner: Karen Strahan, PhD (Cantab), Head of Editorial
Planner: Tommy O'Sullivan, CME Manager
Estimated Time to Complete
2 hours
Target Audience
- Physicians (General Internal Medicine, Family Physicians)
- Nurses
- Nurse Practitioners
- Physician Assistants
- Paramedics
Learning Objectives
Upon successful completion of this activity, you will be able to:
- Describe the pathogenesis of atrial flutter and atrial fibrillation and how this relates to expected ECG findings
- Recognize the conditions frequently misdiagnosed as atrial fibrillation and the pitfalls commonly encountered in the diagnosis of atrial flutter
- Explain the limitations of the computer interpretation in the diagnosis of atrial flutter and atrial fibrillation
- Explain the mechanism of decremental conduction by the AV node
- Appropriately identify and differentiate atrial fibrillation and atrial flutter on the ECG
- Consider and use the clinical context in the ECG diagnosis of atrial flutter
Activity Content
- Introduction
- The Frontal Schematic
- Atrial Fibrillation: The Mechanism of Chaos
- Atrial Fibrillation: ECG Findings
- What is Atrial Flutter?
- Atrial Flutter: Mechanism
- The AV Node: Decremental Conduction
- Atrial Flutter and Decremental Conduction
- Atrial Flutter: ECG Finding
- Atrial Flutter: An Illustrative Case
- Atrial fibrillation and Flutter: Clinical Approach
- Quiz
- Quiz Explanation
Release Date
28-MAY-2019
Expiration Date
28-MAY-2022
Instructions for Participation
Participants must complete the online activity during the valid period as noted above.
Follow these steps:
- View videos in sequence
- Complete quiz
- View and complete post quiz video to support learning outcomes and objectives
- Complete the activity evaluation form to provide feedback for continuing education purposes and for the development of future activities
- Download the Certificate of Completion
Relevant Financial Disclosures
Planners and faculty for this activity have no relevant financial relationships with commercial interests to disclose.
Bibliography
Bogun F et al. Misdiagnosis of atrial fibrillation and its clinical consequences. Am J Med 2004;117(9):636-42.
Garcia TB and Garcia DJ. Arrythmia recognition: the art of interpretation. 2nd edition. Jones and Bartlett learning, 5 Wall Street, Burlington, MA.
Kadish AH et al. ACC/AHA Clinical Competence Statement on Electrocardiography and Ambulatory Electrocardiography. Circulation 2001; 104:3169-78.
Khan R. Identifying and understanding the role of pulmonary vein activity in atrial fibrillation. Cardiovascular research 2004;64(3):387-94.
Nishida K et al. Atrial fibrillation pathophysiology: implications for management. Circulation 2011;124:2264-74.
Seery JP and Ryan J. Why does atrial flutter fool us so often? Top ten tips to minimise uncertainty. https://acadoodle.com/articles/why-does-atrial-flutter-fool-us-so-often-top-10-tips-to-minimize-uncertainty
Seery JP and Ryan J. How to diagnose atrial fibrillation-top 5 tips. https://acadoodle.com/articles/how-to-diagnose-atrial-fibrillation-top-5-tips
Shiyovich A et al. Accuracy of diagnosing atrial flutter and atrial fibrillation from a surface electrocardiogram by hospital physicians: analysis of data from internal medicine departments. Am J Med Sci 2010;340(4):271-5.
Smulyan H. The Computerised ECG: Friend and Foe. Am J Med 2019 132:153-60.
Waldo AL. Mechanism of atrial flutter and atrial fibrillation: distinct entities or two sides of a coin? Cardiovascular research 2002;54(2):217-29.
