Coarse atrial fibrillation - ECG

Atrial fibrillation is recognized on ECG by the absence of P waves and presence of fibrillary waves. Sometimes fibrillary waves may be quite fine so as to be almost unrecognizable in certain leads. In such cases, absence of P waves and a totally irregular RR interval will give the clue to the presence of underlying atrial fibrillation. It may be difficult to recognize the irregularity of RR interval when the ventricular rate is fast, especially in a short ECG strip. Looking at a long rhythm strip and close scrutiny of RR intervals to locate 50% variation between the longest and shortest RR intervals is useful in clinching the diagnosis of atrial fibrillation in such cases. In this ECG the diagnosis of atrial fibrillation (AF) is not difficult because the fibrillary waves are coarse and easily visible in leads V1 and V2. Coarse AF indicates atrial enlargement. Such types of atrial fibrillation is likely to be persistent unless the cause of atrial dilatation is reversible with an intervention like balloon mitral valvotomy. Coarse AF can also mimic atrial flutter. Hence some even call it as flitter or flutter-fibrillation.