Figure: ECG Atrial flutter with 4/1 AV block

Introduction

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36 yrs     Female     BP 120/50     63 in      248 lb

PR
QRS: 102      Atrial flutter with predominant 4:1 AV block
QT:  451      Atrial rate 249. Ventricular rate 63.
QTc: 462

 Axes        Right axis deviation.
             Probable RVH. R/R' in V1, large S in I, V6, right axis deviation.
P:
QRS: 234
T:    51

Courtesy of Kerala Serio, M.D. UCSF Fresno.