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Atrial Flutter with Variable AV Conduction

Description

This EKG was initially read as atrial fibrillation; however the underlying rhythm is atrial flutter with variable AV conduction. Subtle flutter waves can be most clearly seen in leads V1 and V2, with an atrial rate of approximately 300 bpm. The AV conduction ratio fluctuates between 2:1 and 4:1. The EKG also shows left axis deviation and abnormal R wave progression.

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