Typical Atrial Flutter (Counterclockwise) vs Atrial Fibrillation: clinical and ECG differences
Side-by-side comparison of Typical Atrial Flutter (Counterclockwise) and Atrial Fibrillation according to the MioAtlas 3D cardiac simulator model.
Findings by layer and diagnostic parameters
| Layer / Finding | Typical Atrial Flutter (Counterclockwise) | Atrial Fibrillation |
|---|---|---|
| Clinical summary |
Macroreentrant circuit around the tricuspid annulus, dependent on the cavotricuspid isthmus (CTI). Counterclockwise activation generates negative 'sawtooth' F waves in inferior leads (II, III, aVF) and positive F waves in V1. Atrial rate ~300 bpm, typically with 2:1 AV block resulting in ventricular rate of ~150 bpm. |
Complete disorganization of atrial electrical activity with chaotic multiple wavelets, often initiated by pulmonary vein triggers. Total loss of effective atrial contraction. Absence of P waves; presence of irregular 'f' waves and completely irregular ventricular response ('irregularly irregular' rhythm). |
| Heart rate |
150 bpm (min: 75, max: 150) |
125 bpm (min: 90, max: 170) |
| QRS duration |
90 ms |
90 ms |
| Mechanism |
reentrada |
reentrada |
| AV conduction |
2:1 |
variable |
| Key leads |
II, III, aVF, V1 |
V1, II |
Sources and bibliographic references
Typical Atrial Flutter (Counterclockwise)
- Anderson RH, Yanni J, Boyett MR, Chandler NJ, Dobrzynski H. The anatomy of the cardiac conduction system . Clin Anat (2009) . DOI: 10.1002/ca.20700
- Kligfield P, Gettes LS, Bailey JJ, et al. Recommendations for the standardization and interpretation of the electrocardiogram: Part I: The electrocardiogram and its technology . Circulation (2007) . DOI: 10.1161/CIRCULATIONAHA.106.180200
- Sovilj S, Magjarevic R, Lovell NH, Dokos S. A simplified 3D model of whole heart electrical activity and 12-lead ECG generation . Comput Math Methods Med (2013) . DOI: 10.1155/2013/134208
Atrial Fibrillation
- Anderson RH, Yanni J, Boyett MR, Chandler NJ, Dobrzynski H. The anatomy of the cardiac conduction system . Clin Anat (2009) . DOI: 10.1002/ca.20700
- Kligfield P, Gettes LS, Bailey JJ, et al. Recommendations for the standardization and interpretation of the electrocardiogram: Part I: The electrocardiogram and its technology . Circulation (2007) . DOI: 10.1161/CIRCULATIONAHA.106.180200
- Sovilj S, Magjarevic R, Lovell NH, Dokos S. A simplified 3D model of whole heart electrical activity and 12-lead ECG generation . Comput Math Methods Med (2013) . DOI: 10.1155/2013/134208