Atrial flutter. Tracing an elusive arrhythmia

Seven bried case reports representing variations of atrial flutter point up important considerations bearing on diagnosis: situations predisposing individuals to atrial flutter with 1:1 atrioventricular conduction, the need for special care in placing ECG leads for continuous monitoring, the use of carotid sinus massage to unmask atrial flutter, the infrequent but not rare association of Wenckebach block, the possible presence of diffuse disease of the conduction system, the possibility of initiation of atrial tachyarrhythmia by a premature atrial impulse, and possible inherent limitations of routine ECGs.