Atrial Flutter Follow-up

ANSWER
The ECG reveals sinus tachycardia with possible left atrial enlargement and a nonspecific T-wave abnormality. Sinus tachycardia is evidenced by a sinus rate > 100 beats/min, with one corresponding QRS complex for each P wave.

The criteria for left atrial enlargement include a P-wave duration ≥ 0.12 s in lead II, notched P waves in the limb leads, and a biphasic P wave in lead V1, with the terminal portion of the P wave (corresponding to the left atrium) being negative with a duration of ≥ 0.04 s and a depth ≥ 1 mm. (The echocardiogram shows a left atrial measurement at the upper limits of normal.) 

Nonspecific T-wave changes are again seen in the precordial leads. Based on these findings, there is no structural disease to suggest a cause for this patient’s episode of atrial flutter.