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Willy Frick @willyhfrick.bsky.social · 12/01/2025

This is atrial flutter with multi-level block. Theoretically, the possible block levels from top to bottom are: 1. 2:1 2. Wenckebach 3. 2:1 But any of the three levels may be conducting 1:1 rather than blocking. This phenomenon is more common than I used to realize.

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Willy Frick @willyhfrick.bsky.social · 12/01/2025

You count up the number of flutter waves and R waves in a cycle before the pattern repeats and then you can work out the math. In this case, you end up with 5 flutter waves for every 2 R waves. How do you possibly get that math with the block levels I described?

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Willy Frick @willyhfrick.bsky.social · 12/01/2025

Since it's an odd number of atrial waves, you know the first 2:1 level cannot be operative, because you'd end up with a non-integer number of impulses in the second level, specifically 5/2 or 2.5. So then if we have Wenckebach followed by 2:1, how do we get from 5 to 2?

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