Is this atrial flutter rather than sinus rhythm as reported?

[Rambler398]

6 years in permanent AFib after failed ablation for AFlutter

If yes, is this a known problem with Kardia?

[wilsond]

Not sure what you mean? You say you are in permanent AFib,but this kardia shows NSR? AFlutter is characterby a very high regular rate

[Rambler398 in reply to wilsond]

Thank you for your reply. I have been in permanent AFib for 6 years. Today to my surprise my heart rhythm is regular.

My understanding is that with atrial flutter, the ventricular rate is a factor of 240 - 300.

This would typically be 150, 100, 75, 60, and very occasionally 300 bpm.

So for people with a regular ventricular rate of 60 or 75 or thereabouts, they may (rarely) be falsely reassured that the rhythm is sinus. And Kardia may report sinus rhythm, as in this case, when in fact the rhythm is more likely atrial flutter with 4 or 5 degree block. In my opinion only obviously.

[Buffafly]

That’s what’s known as a ‘noisy’ recording I think.

[Rambler398 in reply to Buffafly]

Thank you. If it were simply a noisy recording, which I agree it looks like, I would expect a noisy recording in AFib in my case, since I have been in permanent AFib for 6 years. My radial pulse today is regular and Kardia reports sinus rhythm.

[Buffafly in reply to Rambler398]

Well, great news! How often do you check? I can’t see a p wave but then I don’t have a visible one.

[Rambler398 in reply to Buffafly]

Roughly every 10 minutes ! 🙂

No in fact I don’t check it at all, but for me a regular rhythm is so subjectively different from my atrial fibrillation that I immediately recognise it as such.

It may sound strange but a regular rhythm for me brings a sense of tranquility.

When I have been in flutter in the past, the rate has always been between 50 and 60, which may reflect my apparent vagal AFib. The only exception was when I was given Flecainide without rate control.

[Buffafly]

Atrial Flutter, usually about 150 bpm, can be 100 or 75

Flutter

[mjames1]

It sure looks like normal sinus rhythm which means you are not in permanent atrial fibrillation.

Jim

[Buffafly]

Lifeinthefastlane.com has a lot of interesting info about flutter

[Rambler398 in reply to Buffafly]

Thanks for the link.

Who knew that the now ubiquitous Bismuth, Iodoform and Paraffin paste, was introduced by Rutherford Morison (1853-1939) , Professor of Surgery at the Royal Victoria Hospital, Newcastle

“James Rutherford Morison, one of the most successful British surgeons, a fearless and practical operator, was remembered for his invaluable contributions in fields of surgery and anatomy. Three-quarters of a century ago, he described the surgical anatomy of the right posterior intraperitoneal subphrenic space which has been known as Morison pouch and pointed out that this space has importance for the surgical treatment of gallstones and the postoperative drainage in biliary surgery”

[Ppiman]

Atrial flutter, without any medication is usually ~150bpm (2:1 conduction, with the atrium itself beating regularly at ~300bpm). No rate that isn't a fixed ratio of 300bpm can generally occur because of the effect of the AFl on the AV node, so heart rates can be such as 60, 100, 150, etc).

Your ECG looks like NSR to me, but there is a lot of interference between the heart beating to make the "P" wave hard to detect.

It would be helpful to know what symptoms you were feeling when you took the Kardia, and what age you are. Also, perhaps run a simple Kardia holding with your index finger and thumbs, or sitting at a table using two finger tips, rather than using the three electrodes as it's harder to find a comfy position to do this and that can increase electrical noise.

Steve

[Rambler398 in reply to Ppiman]

Thanks Steve, good information as always.

I’m 75 and was feeling very well at the time of the first trace. Calm and relaxed which is not always the case for me when in AFib. I can always tell when I my rhythm is regular and in AFl generally with a rate of between 50 and 60

Today the rhythm is irregular as usual, and Kardia 6L reports Unclassified though to me it looks like AFib.

[Ppiman in reply to Rambler398]

I used to get so many Unclassified as I have a wide QRS from intermittent bundle block (LBBB). In the end I switched to an AI device by Wellue, which is decidedly better for me but even that is fooled by the LBBB, sometimes reporting VT alarmingly when it’s not.

This morning, I’ve had AF from 10.00 and it’s just ended (12.40). My Apple Watch got the rhythm right more often than my ECG device, but most readings from both were correct.

Steve

Steve

[Rambler398 in reply to Ppiman]

Today’s Kardia original single lead

Monochrome ECG strip using original Kardia

[Ppiman in reply to Rambler398]

It looks like there’s a clear “p” wave there, the little blip before the big ventricular contraction. That’s a noisy NSR reading.

Steve

[Pottsgene]

what are your views on the kardia devices?? I have been looking at them for myself but unsure if will relax my health anxiety or make it worse.

[Rambler398 in reply to Pottsgene]

I prefer the original version which is more convenient to use but if you want to show a 6 lead trace to your cardiologist then the 6L is obviously the one to go for.

Your health anxiety (your words) is very understandable, but you may feel that being better informed about your AFib gives you a measure of control, and that in itself can be reassuring.

Do look at threads here on the Kardia, but consider newer alternatives which some consider to have more accurate reporting algorithms.

Ppiman and mjames1, to name just two amongst many I’m sure, are well informed about these devices.

[ozziebob in reply to Rambler398]

"12 lead mode"? Not sure I understand. I know you displayed your 6 lead ecg in your Post.

The image below is more for Pottsgene .

6 leads of Kardia 6L

[Rambler398 in reply to ozziebob]

Thank you for pointing out my mistake. I tried to edit my reply, but now it seems to have disappeared, so I have revised it. Sorry for the confusion.

[Rog_S]

From personal experience, atrial flutter can be misdiagnosed as NSR. I was in flutter at 120 bpm (normal 60bpm) and 2 ECG plus 2 doctors said I was fine. Felt wrecked for a week before I was called back for electrocardioversion .

[Rambler398 in reply to Rog_S]

I agree with you absolutely. When I am very occasionally in Atrial Flutter, rather than permanent AFib , my rate has generally been 60 bpm and with regular rhythm. And I feel great.

My GP would miss the flutter waves (which is easily done), and tell me it was sinus rhythm. The Kardia algorithm has made the same error.

[dtjag11]

Kardia has 6 Advanced Determinations. I do not believe AFlutter is one of them.