Flutter-Like P Waves in a Case of Atrioventricular Reciprocating Tachycardia

Typical atrial flutter is characterized by its sawtooth flutter wave in leads II, III, aVF, and V1. Atrioventricular reciprocating tachycardia is characterized by its small retrograde P wave after completion of QRS complex, where sawtooth flutter-like P waves are rarely seen in the electrocardiogram during atrioventricular reciprocating tachycardia. We report on a 62-year-old patient who presented the characteristic sawtooth flutter-like P waves in the electrocardiogram during attack of supraventricular tachycardia. By electrophysiologic study, the mechanism of his supraventricular tachycardia was atrioventricular reciprocating tachycardia using the left posterior lateral concealed accessory pathway for retrograde conduction. The accessory pathway was successfully ablated by radiofrequency ablation therapy.