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Challenges in Clinical Electrocardiography |

Flutter Waves in a Dialysis Patient—Discussion

Arch Intern Med. 2011;171(18):1623-1624. doi:10.1001/archinternmed.2011.463.
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Correspondence: Dr Tanawuttiwat, Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, 1611 NW 12th St, Room Central 409, Miami, FL 33136 (ttanawuttiwat@med.miami.edu).

Financial Disclosure: None reported.

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Figure 2. Evaluation of the 12-lead electrocardiogram (ECG). A, Inspection of the 12-lead ECG during continuous venovenous hemodialysis (CVVHD) revealed prominent P waves prior to QRS complexes in leads II, aVF, and V1 (black arrows) with different morphology compared with the other flutter waves in leads V2 and V3 (white arrows). B, When the CVVHD machine was paused, the 12-lead ECG showed normal sinus rhythm with a premature atrial complex in the same ventricular rate (73/min).

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