🔴 Self terminating 2:1 atrial flutter of 150 bpm

This case concerns a 53-year-old male with a history of atrial flutter and arterial disease. During a user-initiated spot check, the PPG recording showed a regular ventricular rate of approximately 150 bpm, which is consistent with a 2:1 atrial flutter conduction pattern. Midway through the 60-second recording, the rhythm spontaneously converted back to a normal regular rhythm.

Although the recorded segment of rapid, organized rhythm lasted less than 30 seconds, current AF guidelines define clinical atrial fibrillation as an ECG-documented episode lasting ≥30 seconds, and similar thresholds are used in electrophysiology consensus documents for AF, atrial flutter, and atrial tachycardia recurrence. Therefore, a captured episode shorter than 30 seconds does not meet the formal diagnostic duration criterion.

However, because this was a symptomatic, patient-triggered measurement, and the 150 bpm rhythm was already present from the very first recorded beats, it is reasonable to assume the arrhythmic episode had begun prior to the start of the measurement. This makes the observed pattern clinically relevant and highlights the value of user-initiated spot checks in documenting arrhythmias that are already ongoing at the time of recording.

Takeaway
While FibriCheck does not diagnose AFib or atrial flutter, PPG recordings can clearly display ventricular response patterns that are compatible with a 2:1 atrial flutter conduction, such as a regular rhythm at approximately 150 bpm. Even when the captured duration is <30 seconds, a user-initiated spot check often reflects an arrhythmia already in progress, offering documented clinically meaningful insights—especially in patients with a known history of atrial arrhythmias.

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