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:

1. View videos in sequence
2. Complete the quiz
3. View post quiz video to support learning outcomes and objectives
4. Complete the activity evaluation form to provide feedback for continuing education purposes and for the development of future activities
5. Download the Certificate of Completion

Relevant Financial Disclosures

Acadoodle adheres to the ACCME's Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CE activity, including faculty, planners, reviewers or others are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.

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.