Electrocardiographic Considerations Related to the Atrioventricular Conduction Property in Atrial Flutter

Takao Katoh

doi:10.5105/jse.46.236

October 31, 2026Japanese Journal of ElectrocardiologyOpen Access

Electrocardiographic Considerations Related to the Atrioventricular Conduction Property in Atrial Flutter

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Key Points

To investigate the electrocardiographic characteristics of atrioventricular conduction, including flutter cycle length (FF interval) and conduction time (FR interval), in common and uncommon atrial flutter.
Analyzed 12-lead electrocardiograms from 65 consecutive adults (mean age 66.2 ± 11.2 years; 37 common type, 28 uncommon type) identified from approximately 50,000 health checkup screenings.
Measured flutter cycle lengths (FF interval) and atrioventricular conduction times (FR interval) to evaluate fixed versus variable conduction patterns and associated cardiac abnormalities.
Variable conduction ratios occurred in most cases (22/37 common, 14/28 uncommon); among fixed cases, uncommon flutter showed only even ratios (2:1, 4:1), whereas common flutter included odd ratios (1:1, 3:1).
Fixed conduction cases showed a significant negative correlation between FF interval and atrioventricular conduction ratio (r = -0.51, p < 0.01).
In variable conduction cases, maximum FR intervals were significantly longer and the FR variation was significantly wider in uncommon compared to common flutter (90.7 ± 32.9 vs 58.6 ± 34.8 msec, p = 0.009).

Structured PICO

P

Population

65 consecutive healthy adults with confirmed atrial flutter (37 Type I common, 28 Type I uncommon, 0 Type II) identified from approximately 50,000 12-lead ECGs recorded during community and corporate health checkups in Japan; age range 47 to 91 years, mean age 66.2 ± 11.2 years.

I

Intervention

12-lead electrocardiographic (ECG) evaluation and measurement of atrial flutter type, atrioventricular (AV) conduction ratio, flutter cycle length (FF interval), AV conduction time (FR time), and comorbid ECG findings

C

Comparator

Comparison between common type atrial flutter (n=37) and uncommon type atrial flutter (n=28), as well as between fixed AV conduction ratio cases (n=25) and variable AV conduction ratio cases (n=36)

O

Outcome

Atrioventricular (AV) conduction characteristics, including AV conduction ratio patterns (fixed vs. variable), flutter cycle length (FF interval), and AV conduction time (FR time) measured on 12-lead ECGsurrogate

Limitations

Selection bias due to sampling from asymptomatic or mildly symptomatic individuals undergoing routine health checkups, resulting in the absence of Type II atrial flutter cases
Lack of clinical background information such as comorbidities, disease state, treatment history, and history of atrial fibrillation
Inability of surface 12-lead ECG alone to precisely evaluate electrical activity within the AV node entrance and AV node without intracardiac mapping
AV conduction ratio was assessed at a single time point during ECG recording, representing an unstable indicator that may vary at different times
Measurements were performed by a single investigator

Implication

This ECG analysis confirms a significant negative correlation between flutter cycle length and AV conduction ratio in fixed-ratio atrial flutter, reinforcing the clinical warning that prolonging the flutter cycle with antiarrhythmic drugs may lower the conduction ratio and paradoxically accelerate the ventricular heart rate.

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Cite This Study

Takao Katoh (2026) studied this question.

synapsesocial.com/papers/6ae86752b29eedd18672877b https://doi.org/10.5105/jse.46.236

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Electrocardiographic Considerations Related to the Atrioventricular Conduction Property in Atrial Flutter

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Electrocardiographic Considerations Related to the Atrioventricular Conduction Property in Atrial Flutter

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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